Influence of pacemaker-induced tachycardia with A-V block on left ventricular blood velocity in man. Phasic instantaneous left ventricular blood velocity was measured by radiotelemetry in 28 subjects with a Doppler ultrasonic flowmeter catheter during atrial pacing and induced A-V block Type I Wenckebach A-V block with conduction ratios of 9:8 or lower generally produced a stepwise reduction of peak left ventricular blood velocity in relation to shortened R-R intervals. Longer Wenckebach periods resulted in little or no blood velocity alteration during 1:1 A-V conduction. Those beats following a blocked atrial depolarization were associated with augmented blood velocities. In three subjects, bigeminal periods of 3:2 A-V block resulted in larger left ventricular blood velocities when compared with 2:1 A-V block, despite identical R-R intervals following the blocked P wave. This latter phenomenon was attributed to diastolic augmentation of left ventricular contraction following the second and hemodynamically ineffective beat during 3:2 A-V block. Three patients manifested true blood velocity alternation during second-degree A-V block and changing R-R intervals. The variations in peak left ventricular blood velocity observed during atrial pacing and A-V block are related to changing inotropic state and cycle length dependent alterations of left ventricular diastolic filling.


The effects of lidocaine on the canine ECG and electrophysiologic properties of Purkinje fibers. Effects of selected plasma lidocaine concentrations on the action potentials of isolated canine Purkinje fibers were studied with microelectrode techniques and a method for perfusing PF with the arterial blood of a normokalemic dog. Lidocaine was administered to the donor as an intravenous injection of 0.5 to 2.0 mg. per kilogram or as an intravenous infusion of 4 to 50 mug per kilogram per minute and plasma concentrations were determined by gas chromatography. At plasma lidocaine concentrations from 0.2 to 9.9 mug per milliliter no significant changes in donor arterial pressure, heart rate, or electrocardiographic P-R and QRS intervals occurred, and Purkinje fiber resting membrane potential was unchanged. Donor Q-T intervals were unchanged at lower lidocaine concentrations (up to 4.0 mug per milliliter) and decreased at higher levels (4.1 to 9.9 mug per milliliter). Purkinje fiber AP changes commenced in 2 to 3 minutes of lidocaine injection. At lower lidocaine levels AP amplitude, maximum slope of phase 0 depolarization (Vmax) AP duration, and effective refractory period decreased, membrane responsiveness was depressed, and automaticity of spontaneously firing Purkinje fibers decreased. These changes were accentuated at higher lidocaine concentrations. Conduction usually was unchanged or slowed at lower plasma lidocaine levels and slowed at higher concentrations. When ouabain-intoxicated preparations were studied, lidocaine exerted a depressant effect on the AP. These studies indicate that the mechanisms whereby therapeutic lidocaine concentrations may modify arrhythmias are not unlike those of other local anesthetics and include depression of Vmax, membrane responsiveness, and conduction.


Effects of coronary arteriography on atrioventricular conduction. Studies with His bundle electrography. The effect of coronary arteriography on atrioventricular (A-V) conduction was studied in 26 patients with the use of His bundle electrography. Slowing of atrioventricular conduction (prolonged A-H interval) was observed in all 26 pateints following either left or right coronary arteriography without a detectable change in the H-V interval. In four patients with left coronary preponderance in arterial distribution pattern, prolonged A-H inverval was produced only by injecting the contrast material into the left coronary artery. Conversely, in the remaining 22 patiens either with right preponderance or balanced distribution, prolongation of the A-H time was a result of opacification of the right coronary artery. The A-H interval at peak prolongation (133.9 +/- 18.7 [S.D.] msec.) was significantly higher than the control measurement (98.3 +/- 15.7 msec.) (P less than 0.0001). Prolongation of the A-H interval started around 4 seconds after the initiation of injection, reached its peak at an average of 7.7 seconds, and subsided within 20 seconds. When intracoronary injection of 6 ml. of normal saline was made in these 26 patients, no change was observed in the His bundle electrograms. On the other hand, hypertonic (20 per cent) glucose solution, when injected into coronary arteries, had an effect remearably similar to  that of contrast material on A-V conduction. These findings suggest that prolonged A-H interval observed during coronary arteriography may be a result of osmotic effect of the contrast material, rather than hypoxia resulting from dilution of coronary blood flow.


Echocardiographic analysis of intracardiac anatomy in endocardial cushion defect. A standard echocardiographic technique was proposed for an analysis of the intracardiac anatomy of endocardial cushion defect (ECD). It consisted of two beam directions, mitral and tricuspid, and two M-mode scans, between the mitral and tricuspid valves and between the mitral and aortic valves. Using this technique, echocardiographic studies were performed on 13 patients with ECD, including 10 patients with the incomplete form and three patients with the free-floating form. In patients with the incomplete form, an M-mode scan between the mitral and tricuspid valves showed the specific features of the interaction between the mitral valve, the interventricular septum, and the tricuspid valve, termed the "mitral-interventricular septal-tricuspid (MVT) connection." The systolic multiple echoes and the diastolic echoes of the so-called posterior leaflet of the mitral valve were constant findings in the mitral direction. The tricuspid valve, although less continuous, was recorded simultaneously with the mitral valve in the same direction. Ateriorly displacement of the anterior mitral leaflet was shown on an M-mode scan between the mitral and aortic valves, giving an echocardiographic representation of the angiocardiographic "goose-neck" sign. Evidence showing the presence of right ventricular volume overload was also found. In patients with the free-floating form, an anterior common A-V valve with a large excursion was recorded on an M-mode scan between the mitral and tricuspid valves. The valve was located posterior to the interventricular septum in the mitral direction and anterior to the septum in the tricuspid direction. There was no finding to show the interaction between the valve and the septum. The posterior common A-V valve was registered only in the mitral direction. Our technique made it possible to diagnose ECD, using a noninvasive echocardiographic method, and discriminate the free-floating form from other forms of ECD.


Rate of change of ventricular power: an indicator of ventricular performance during ejection. An expression representative of the rate of change of ventricular power during ejection was derived. The primary advantages of the expression are its theoretical value and its ability to characterize ventricular performance. The rate of change of ventricular power, measured during ejection, is virtually free of assumptions. It has a fluid dynamic as well as a physiological meaning. It serves in an integrative fashion by combining terms previously shown to be of functional significance. Studies in dogs show that it reflects alterations of the inotropic state yet is relatively independent of alterations of preload or afterload. In nine dogs isoproterenol caused the peak rate of change of power to increase from (10 +/- 2) X 10(8) to (15 +/- 3) X 10(8) dynes-cm. sec.-2 (mean +/- S.E.) (P less than 0.01). Propranolol produced a reduction from (10 +/- 2) X 108 to (6 +/- 1) X 10(8) dynes-cm. sec.-2 (P less than 0.001). An increased afterload induced by angiotensin caused no change of the peak rate of change of power. Augmentation of the preload with dextran, which caused a 40 per cent increase of the end-diastolic volume, produced a statistically insignificant increase of the peak rate of change of power from (12 +/- 3) X 10(8) TO (16 +/- 4) X 10(8) dynes-cm. sec.-2 The rate of change of ventricular power, measured during ejection, therefore appears to be a useful and meaningful indicator of ventricular performance that has many desirable characteristics.


Aortic valve closure: echocardiographic, phonocardiographic, and hemodynamic assessment. The temporal relationship between the closure of the aortic valve (AoV) and the onset of the aortic component of the second heart sound (A2) was defined by simultaneous recording of AoV echogram, phonocardiogram (PCG), and electrocardiogram in 25 subjects. Ten subjects had no heart disease (normal); 15 suffered from various cardiac conditions other than AoV disease (patients). The point of coaptation (C) of the AoV cusps to the onset of A2, the C-A2 interval, was measured to the nearest 5 msec. in 125 cycles. Fifty-eight cycles had a C-A2 of 10 msec., and 47 cycles had a C-A2 of 15 msec. The remainder were distributed at intervals below 10 or above 15 msec. The average C-A2 interval was 11.48 +/- 0.38 msec. (mean +/- 1 S.D.). A similar distribution pattern was observed when the total number of cycles was divided into "normal" and "patient" groups. In 3 subjects, simultaneous equisensitive (catheter-tip micromanometer) left ventricular and central aortic pressures, PCG, and AoV echograms were recorded. C-A2 ranged from 0 to 10 msec.; the interval between left ventricular and aortic pressure at the level of the incisura-hangout interval-ranged from 8 to 20 msec. Inhalation of amyl nitrite in one subject produced a significant fall in arterial pressure, accompanied by prolongation of the hangout interval from 10 to 20 msec. and of the C-A2 interval from 0 to 8 msec. Thus, the C-A2 interval is an integral part of the hangout time. Data suggest that A2 does not originate from the coaptation of the aortic valve cusps per se, but is related to events that occur at the time of or slightly after coaptation.


Postmyocardial infarction (Dressler's) syndrome: report of a case with immunological and viral studies. A case of PMIX with immunologic and viral studies obtained prior, during, and after a typical exacerbation are reported. Immunologic studies indicated the presence of humoral antiheart autoantibodies, and an increase in the number and proportion of lymphocytes containing surface IgG immunoglobulin during acute activity. Viral studies were negative. Previously reported immunologic and viral data, as well as etiology and pathogenesis of PMIS are discussed.


Diagnostic features of right ventricular myxoma. The clinical diagnostic features of right ventricular myxoma are described in a recent patient and related to the 15 cases previously reported. The presence of a pulmonic systolic ejection murmur with a delayed (120 to 140 msec.) and accentuated pulmonic second sound, or calcification in the region of the right ventricular outflow tract should suggest this lesion. Cardiac catheterization with angiocardiography in diagnostic. Ga scanning may assist in the diagnosis and followup after surgical removal of the myxoma. Early surgical removal will avoid the possibility of sudden death.


Improved methods for sampling and analysis of vinyl chloride. An analytical scheme was developed for vinyl chloride, which is applicable to ambient and in-plant atmospheres. Using computerized gas chromatographs equipped with automatic injection system and flow rate control, high reproducibilities are achieved in the ppb range. Samples from various sources have been analyzed.


Importance of initial management of persons internally contaminated with radionuclides. The first one to three hours following a radiation accident during which internal contamination occurs provide the best and perhaps the only opportunity for preventing uptake of radionuclides. By using chemical manipulation in the GI tract or by hastening the material through the body, absorption can be reduced. Once absorbed, uptake in specific tissues can often be prevented by blocking agents, isotopic dilution or chelating agents. In order to supply prompt treatment, the medical department must have a well-defined action plan based on knowledge of the plant or laboratory operations, the radionuclides used, and medications required.


Chemical properties of cotton dust.

Chemical properties of cotton dust. Byssinosis, a respiratory disease, is caused by dust in cotton textile mills. The heterogeneous, complex dust varies in composition and activity in different "cotton-related" processing operations. Information concerning the constitution of "cotton dust" is reviewed. Relevance of a single dust standard for all cotton operations is discussed.


Dosimeter for oxides of nitrogen.

Dosimeter for oxides of nitrogen. A simple, lightweight, prototype dosimeter, based on wet chemical principles, has been developed for personal monitoring of NO2. A simple modification provides for the determination of NOx. This device requires no auxiliary equipment and is intrinsically safe for use in coal mines. In use, NO2 permeates a membrane and is absorbed in acidic aqueous solution containing hydrogen peroxide. The latter oxidizes NO2 to nitrate. When a total NOx determination is required, an oxidizing prefilter converts NO to NO2 prior to conversion to nitrate in solution. The NO3--is determined in the laboratory with a specific ion electrode. The NO2 or NOx is determined from the NO3--found with reasonably good precision and accuracy. Caution should be exercised when using a dosimeter to determine compounds having a "C" value. These devices will not indicate an excursion concentration existing during a limited time. Effects due to dosimeter orientation, liquid evaporation, and temperature (above 15 degrees) were insignificant. Prior to field testing, it would be desirable to conduct more extensive laboratory tests. The entire TLV range of NO (up to 25 ppm) should be covered, and exposure of the dosimeters to known mixtures of NO and NO2 should be evaluated. Tests against specific interferences should also be performed.


Evaluation of charcoal sampling tubes.

Evaluation of charcoal sampling tubes. The effectiveness of MSA charcoal tubes and those constructed by the USAF Environmental Health Laboratory were statistically compared. No significant differences were noted. Also, tube recovery efficiencies were determined for 10 different solvents for which there was no or limited data. The effects of moisture on gravimetric analysis are presented.


Solubility and reactivity of sulfur dioxide in various oils. Physical-chemical interactions of SO2 and soluble particulate matter have been documented in the potentiation of acute respiratory effects in animals. The possible role of such interactions between SO2 and oils will be examined similarly. By a simple electrochemical technique, the solubility of SO2 in various oils (including motor oils) could be isolated from the chemical reactions. Except for the medicinal mineral oil, large differences in both solubility and reactivity were found among the oils. In these oils, far more SO2 reacted than dissolved.


A procedure for the early detection of noise-susceptible individuals. Currently used threshold audiograms fail to detect the early stages of noise-induced hearing impairment. Threshold shifts may reach 10 to 15 dB before the impairment is detected. Loudness difference limen and critical band phenomena should provide an earlier and more sensitive test for such hearing impairment.


Biological effects of trinitrotoluene from exposure below the threshold limit value. Statistically significant rises in serum glutamic oxalacetic transaminase and lactic dehydrogenase determinations occurred at exposures to TNT of 0.8 mg/m3 and persisted at exposures of 0.6 mg/m3. Based on these findings, the adequacy of the current threshold limit value for TNT (1.5 mg/m3) is questioned.


An assessment of the effect of improved working conditions on bladder tumor incidence in a benzidine manufacturing facility. Bladder tumor cases at a dye manufacturing plant showed a statistically significant reduction in incidence of tumors following the advent of process changes and strict industrial hygiene control. A useful method of statistical analysis is employed which may have wider use, especially in cases lacking complete epidemiological data.


Determination of organochlorine pesticides in the tissues of the black mullet (Mugil cephalus) and the silver mullet (Mugil curema). The black or silver mullet is a suitable fish for determining the degree and type of local water pollution. In contrast to the great barracuda which we studied earlier, mullet did not lose significant quantities of body fat and DDT-type pesticides at the expense of the developing gonads.


Early risks of open heart surgery for mitral valve disease. During 1972 and 1973, a total of 235 patients had open heart surgery for mitral valve disease unassociated with significant aortic or rheumatic tricuspid valve disease. Thirty-one underwent closed heart mitral commissurotomy, without mortality. Of the 204 patients undergoing open operation, 125 had sequential measurement of cardiac output and mixed venous oxygen pressure. The hospital mortality rate was 6.4 percent in the larger group of 204 patients and in the 125 with cardiac output measurements. The rate was greater in those with class IV disability (New York Heart Association criteria) preoperatively than in those with class III or II disability. The mean +/- standard deviation of the average cardiac index early postoperatively was 2.05 +/- 0.579 liters-min--1-m--2. Cardiac index was lower in the patients who died early postoperatively than in those who did not. The probability of hospital death was a significant function of cardiac index. The predicted probability of death was 10 percent with an average cardiac index of 1.42 liters-min--1-m--2 and increased sharply with lower indexes. Cardiac index was lower early postoperatively than preoperatively, and was lower in patients in class IV than in those in class III. There was no significant difference in cardiac index between patients with mitral valve replacement and those in repair. A history of closed commissurotomy, age, duration of cardiopulmonary bypass, duration of cardiac ischemia and method of myocardial preservation did not significantly influence cardiac index or hospital mortality rate. There was no significant relation between mixed venous oxygen pressure and hospital death. Further improvement in results of mitral valve surgery requires adequate preservation of left ventricular performance before, during and after operation.


Risk of death related to coronary arteriography: role of left coronary arterial lesions. Seven deaths occurred within 5 days after study in 800 consecutive patients undergoing arteriography. All seven patients had severe anginal symptoms at rest or with minimal exertion, and all had extensive coronary artery disease. Four had left main coronary artery disease, and three had hemodynamically equivalent lesions involving both the proximal left anterior descending and circumflex branches. It is postulated that these deaths are due to a stress imposed upon patients in unstable condition with a particularly extensive myocardial perfusion deficit.


Significance of A-H interval in patients with chronic bundle branch block. Clinical, electrophysiologic and follow-up observations. His bundle electrograms were recorded in 308 adults with chronic bundle branch block. The A-H interval was normal in 249 patients and prolonged in 59. Comparison of patients with normal and prolonged A-H intervals revealed a greater incidence of demonstrable organic heart disease in the latter (P less than 0.01). Dyspnea, cardiomegaly and congestive heart failure were more frequent in patients with A-H prolongation. These patients also had longer P-R intervals and atrioventricular (A-V) nodal effective refractory periods, lower paced rates producing second degree A-V block proximal to the His bundle and a greater frequency of H-V prolongation. All patients were prospectively followed up in a conduction disease clinic with mean follow-up periods (+/- standard error of the mean) of 523 +/- 23 and 588 +/- 47 days in the patients with normal and prolonged A-H intervals, respectively. Seven (3 percent) of the patients with a normal A-H interval had A-V block with probable or definite site of block proximal to the His bundle in three and distal to the His bundle in four. In five of the six patients with a prolonged A-H interval who experienced A-V block (10 percent), the probable or definite site of block was proximal to the His bundle. Mortality (both sudden and nonsudden) was not significantly different in the patients with normal and prolonged A-H intervals. In summary, A-H prolongation was associated with increased incidence of organic heart disease and myocardial dysfunction. The risk of development of A-V nodal block was greater in patients with a prolonged A-H interval but appeared to be of minimal clinical significance.


Some lessons in cardiovascular epidemiology from Framingham. Epidemiologic investigations have provided a portrait of the potential candidate for coronary heart disease. This is important because studies of the evolution of coronary disease in the general population reveal that it is a common disease that frequently attacks without warning, can be silent in its most dangerous form and can present with sudden death as the first symptom. Progress in identifyin- persons in jeopardy and the factors needing correction makes it theoretically possible to interrupt the chain of factors that eventuate in this disease. Coronary disease does not really begin with crushing chest pain, pulmonary edema, shock, angina or ventricular fibrillation, but rather with more subtle signs like a poor coronary risk profile. The risk factors can be treated quantitatively as ingredients of a cardiovascular risk profile and their joint effect estimated. An efficient practicable set of variables for this purpose is a casual blood test for cholesterol and sugar, a blood pressure determination, an electrocardiogram and a cigarette smoking history. With this set of variables the risk of coronary heart diseases can be estimated over a 30-fold range and 10 percent of the asymptomatic population identified in whom 25 percent of the coronary disease, 40 percent of the occlusive peripheral arterial disease and 50 percent of the strokes and congestive heart failure will evolve. The periodic use of the electrocardiogram at rest and after exercise in persons with a poor risk profile can demonstrate persons with asymptomatic ischemic cardiomyopathy due to advanced coronary artery disease. Most cases of angina pectoris or myocardial infarction represent medical failures; the conditions should have been detected years earlier for preventive management. About 30 percent of patients with infraction will shortly experience new angina, have an annual death rate of 4 percent and a fourfold increased risk of sudden death. Reinfarction will occur at an annual rate of 6 percent, and half the recurrences will be fatal. Congestive heart failure must be expected at 10 times and strokes at 5 times the rate found in the general population. Although no major innovations are required to identify candidates for coronary disease and to estimate their risk, we have much to learn about motivating changes in behavior to control risk factors. Approaches to prevention of coronary heart disease include public health measures to alter the ecology in favor of cardiovascular health, preventive medicine directed at highly vulnerable candidates and hygienic measures initiated by an informed public in its own behalf.


Correlation of acute myocardial infarct scintigraphy with postmortem studies. Acute myocardial infarct scintigraphy with technetium-99m-pyrophosphate was performed in a patient with an acute massive transmural infarct. The patient died 12 hours later, and postmortem tracer studies demonstrated a tracer concentration ratio of 13:1 between acutely infarcted myocardium and normal myocardium remote from the infarct. The concentration of tracer in tissue bordering on the infarct but without histologic evidence of acute infarction was 1.5 times that in normal tissue remote from the infarct. In vitro scintigraphy of the excised heart revealed a pattern of tracer distribution similar to that of scintiscans obtained before death. The biologic distribution of 99mTc-pyrophosphate, with large tracer concentrations only within the acutely infarcted tissue, suggests that acute myocardial infarct scintigraphy can be used to estimate the extent of an acute myocardial infarct.


Refractory ventricular tachycardia and fibrillation in a patient with the prolapsing mitral leaflet syndrome: successful control with overdrive pacing. A 56 year old man with the prolapsing mitral leaflet syndrome presented with syncope and recurrent ventricular tachycardia and fibrillation. Treatment with antiarrhythmic agents (lidocaine, procainamide and propranolol) was unsuccessful. Overdrive pacing, in combination with propranolol, successfully suppressed the arrhythmias, and the patient remains well after 15 months of follow-up.


A minimum-surface mechanism to account for the organization of cells into columns in the mammalian epidermis. It has recently been discovered that the stratum corneum and superficial living epidermis of mammalian skin are organized into neat vertical columns of interdigitating cells. The mechanism for this organization has not yet been determined. This study shows that the stacked organization is not unique to the epidermis but also occurs in cork cambium and the pith of woody plant stems. The structural and spatial organization of the stacked cells in these tissues were compared and found to approximate closely the shape of Kelvin's minimum-surface polygon, the tetrakaidecahedron. Paper models of flattened tetrakaidecahedra were constructed and found to stack columns of interdigitating units which are consistent with all of the structural details seen in stacked cells observed under the light and the scanning electron microscopes. Indeed, only polygons of this type are capable of aggregating without interstices in the manner of the stacked cells. A study of stacked arrays of these models has revealed a mechanism by which the epidermis might become organized in columns of stacked and interdigitating cells. The proposed mechanism assumes that cells within an array seek the smallest possible surface-to-volume ratio and, under appropriate conditions, form stacked tetrakaidecahedra.


Platelets, endothelial cells and macrophages in the spleen. An ultrastructural study on perfusion-fixed organs. Rabbit spleens have been examined after perfusion fixation with and without prior washing with various fluids. The platelets were stored in the splenic sinuses and in the cord spaces as single platelets, or in loosely packed aggregates which appeared to be anchored to the endothelium by one or a few platelets. After washing prior to fixation most of the platelets disaggregated and regained their normal shape. Some platelets adhered to morphologically normal endothelium even after prolonged perfusion. Occasionally, platelets were observed inside splenic endothelial cells. Others were closely associated with macrophages, many of which also contained engulfed platelets. There was no morphological evidence of a particular platelet population being retained in the spleen after washing. In the sinuses special granule-rich cytoplasmic structures were observed. They were interposed between ordinary endothelial cells and contained a large number of small lysosome-like granules. Nuclei were never observed in these structures, probably because they consisted of pseudopod-like protrusions. Their origin and function are discussed. They may represent actively phagocytizing elements.


Hysterectomy in the rat: surgical disruption of the vascular channels reduces number of ova shed. Cycling rats were hysterectomized and/or unilaterally ovariectomized (ULO) on day 2 (metestrus). Collateral blood supply to the remaining ovary via the uterine artery was left intact or disrupted. Animals were killed in metestrus after one complete estrous cycle. Control rats were also killed at this time. Counts of tubal ova revealed that intact rats ovulated an average of 4.4 +/- 0.4 eggs per ovary (N = 8). Following ULO, rats (N = 8) ovulated 9.6 +/- 0.2 EGGS. Ligation of the uterine artery decreased the number of eggs ovulated in ULO rats (N = 8) to 5.4 +/- 1.1. Hysterectomized rats (N = 8) ovulated 4.8 +/- 0.5 eggs per ovary. If the blood supply was disrupted, a reduction to 2.7 +/- 0.2 eggs per ovary occurred (N = 8). Hysterectomized and ULO rats (N = 8) ovulated 10.3 +/- 0.4 eggs from the remaining ovary but only 5.0 +/- 1.0 eggs if the collateral blood supply of the uterine artery was not intact (N = 10). The results demonstrate that disruption of the vascular channels during the surgical procedures of hysterectomy and/or ULO results in a reduction of the expected ovulation number.


Loss of synapses in the dentate gyrus of the senescent rat. Synapses were counted in electron micrographs of the middle third of the molecular layer of the dentate gyrus of Fischer 344 rats, 3 months and 25 months of age. A 27% decrease in the number of synapses was found in senescent animals compared with young adults. This loss of synapses could not be correlated with changes in synaptic size. tissue volume or number of postsynaptic granule cells.


The fine structure of the chinchilla placenta. The structure of the placental labyrinth, interlobular or "coarse" syncytium, visceral (splanchnopleuric) yolk sac, giant cells and subplacenta of the chinchilla was studied with the electron microscope. The fine structure of the interhemal membrane of the placental labyrinth was found to be hemomonochorial, consisting of a single layer of syncytial trophoblast. In this respect, the placental labyrinth was similar to that of another caviomorph rodent, the guinea pig. The labyrinthine trophoblast had pinocytotic vesicles as well as larger vaculoes and multivesicular bodies. The interlobular syncytium contained granular endoplasmic reticulum, and in one case from early in gestation there were intracisternal granules in the ER. The visceral endodermal cells of the inverted yolk sac placenta had a well-developed system of apical vesicles and tubules as well as larger cytoplasmic vacuoles. Their appearance was similar to that of endodermal cells found in other rodents which are known to absorb proteins and other substances from the uterine lumen. Towards term the giant cells were often vacuolated and contained large deposits of glycogen as well as lipid droplets. The syncytial trophoblast of the subplacenta contained numerous moderately electron-dense granules which may be secretory in function; cytotrophoblastic cells lacked these granules. The subplacental syncytium often surrounded spaces or lacunae which contained an electron-dense granular material.


Light and electron microscopic study of the degeneration and early regeneration of olfactory epithelium in the mouse. Degeneration and early regeneration of olfactory epithelium from two strains of mice was studied at the light and electron microscopic levels from 12 hours to 3 days following nasal irrigation with 1% aqueous solution of zinc sulfate (ZnSO4) (a compound known to selectively damage olfactory epithelium). Distinct patterns of degeneration and stages of regeneration were evident following treatment. During the first 24 hours after treatment three progressive manifestations of the degenerative process were seen: (1) a relatively mild condition which was characterized by surface irregularities produced by cell protrusions, highly vacuolated cytoplasm, presence of large lysosome-like bodies and prominent intercellular spaces, (2) a more severe condition in which large areas of the epithelium were detached from the basement membrane cellular debris was present in the nasal chamber, and (3) a condition of total or near-total denudation of the epithelium of olfactory mucosa. The basal lamina was continuous and intact in most regions and the integrity of the subadjacent connective tissue was mostly well-preserved. Nerve bundles of the fila olfactoria were noted in varying degrees of degeneration during the course of the experiment. The most advanced neural degeneration was seen 24 to 72 hours after treatment. Onset of regeneration was suggested by the appearance of a simple squamous layer of cells above the basement membrane 48 to 72 hours after treatment. In addition to the simple epithelium a stratified epithelium consisting of two to four cell layers was also observed at this time. Glandular cells, containing secretory granules identical to those in Bowman's glandular cells,  were noted in an apparent process of migration from the lamina propria into the the stratified epithelial layer. The last mentioned observation supports the proposition that new supportive epithelial cells originate from cells of Bowman's gland.


Nitrogen balance and calorie efficiency in small-for-date dwarfism. Accelerated weight gain was induced in eight infants, including two patients with dwarfing syndromes, who were small for their dates of birth and continued to be small after birth. The calorie cost of weight gain was higher than in control infants with linear growth failure due to undernutrition, but the degree of inefficiency did not seem to be of practical significance. Nitrogen retentions were appropriate for weight gain or better. Nitrogen retentions in excess of those expected on the basis of weight gain were seen in infants with small-for-date dwarfism and in controls when calorie intakes were low. The ability to induce good nitrogen retentions is thus no reflection of linear growth potential.


The effects of dietary fatty acids and cholesterol on the milk lipids of lactating women and the plasma cholesterol of breast-fed infants. The plasma cholesterol concentration and the composition of the plasma fatty acids was altered by dietary means in 10 lactating women. The effects of these changes in the plasma on the lipid constituents of mature human milk were studied over periods of several weeks. In eight infants who were being breast-fed, the changes in the plasma cholesterol concentration were correlated with the changes that were induced in the milk lipids. Significant alteration in the women's plasma cholesterol levels did not change the cholesterol concentration in milk. The cholesterol content of milk was closely correlated with the concentrations of the other milk lipids, supporting a functional role for the cholesterol in the secretion of milk fat. In the maternal milk consumed by the eight infants the linoleate content rose from 9.4% to 15.5% of total fatty acids as a result of a moderate increase in dietary polyunsaturated fat. This led to a fall in the infants' plasma cholesterol levels, from an average of 185 to 157 mg/100 ml.


Anthropometric evaluation of the body composition of black, white, and Puerto Rican newborns. One hundred ninety-four white, black, and Puerto Rican infants 1 to 5 days old were measured in the ward nurseries of two Philadelphia city hospitals. In addition to birth weight and length, triceps and subscapular skinfolds and upper arm circumference were obtained. Upper arm muscle circumference was calculated. Females had greater skinfold thicknesses than males but significant differences were found only for the triceps. Whites and blacks did not differ in skinfold thickness, but the Puerto Rican infants had significantly smaller triceps skinfolds. Differences in nutritional status are attributed to environmental factors.


Liver storage iron in Canadians.

Liver storage iron in Canadians. Liver samples were collected at 105 (78 males and 27 females) autopsies carried out on accident victims in seven cities of Canada. The age of individuals ranged from newborn to 89 years but about 75% of them were 19 to 65 years old. The liver iron stores of males were high at birth (150 to 300 mug/g), decreasing to around 100 mug/g in the second year. This level was maintained up to about 15 years and then increased to approximately 250 mug/g in 2 to 3 years. After 55 years, the hepatic iron stores tended to decrease. Although the number of samples from females was small, there was an indication of high stores (above 200 mug/g) at birth followed by a decline to values from 50 to 150 mug/g. This level was generally maintained in females throughout life. Storage iron in the livers of stillborn infants was high, ranging from 200 to 1600 mug/g. Analysis of liver samples from 64 persons (50 males and 14 females) who died of cardiovascular diseased showed that males under 45 years had lower iron stores than the corresponding accident victims.


Sugar as a vehicle for iron fortification. Sugar as a vehicle for iron fortification presents several advantages over the other vehicles used in the last three decades. In vitro studies demonstrated that ferrous sulfate added to sugar in proportion of 1 mg to 1 g, respectively, is maintained in the ferrous form for a period of at least 1 year and does not induce adverse changes in the vehicle. Sugar, by itself, carries practically no inhibitors for the absorption of iron. Iron absorption from fortified sugar mixed with vegetals is the same as that of native vegetal iron. The absorption from fortified sugar is increased more than 50% over that observed from native vegetal when it is administered as a drink during the ingestion of a meal. A further increase in absorption was found when fortified sugar was administered with beverages. The mean absorption ratio of fortified sugar given with orange juice, Coca-Cola, and Pepsi-Cola to a reference dose of iron ascorbate was between 0.45 and 0.66, which is more than 3 times the absorption of this iron fortification mixed with vegetals. The mean absorption ratio from coffee was 0.30, and from coffee with milk, 0.15. These data indicate that the fortification of sugar with iron could be a better procedure for the prevention of iron deficiency than the iron fortification of bread and wheat products, from which iron is poorly absorbed. It could be used in developing countries where beverages are highly consumed by the low socioeconomic class. This program could be extended to all sugar consumption or be restricted to soft drinks.


Low fiber content of Connecticut diets.

Low fiber content of Connecticut diets. Recent theories have postulated that low fiber diets are related to colon cancer and diverticulosis, and to atherosclerosis. These theories are based on British and African diet history information. There has been no recent assessment of fiber intake in an area of high incidence of colonic disease in the United States. Using recall diet histories in subjects with no disease and with colon disease, and correcting our data to account for any loss in recall history, we find a low daily fiber intake in all 21 subjects evaluated, mean 3.5 g, range 1.6 to 11 g. There was no statistical difference in intake among patients with or without colon disease. The data agree with the British findings. Since the incidence of the diseases in question is not uniform in the United States it is suggested that diet surveys are needed in areas where colon carcinoma is of low incidence.


Nutritional status of a population sample in Macon County, Alabama. A nutrition survey was conducted in Macon County, Alabama, with a population sample of 102 individuals, 76% of whom were black. Three 24-hr dietary recalls were obtained for each participant and 24 nutrients and energy were calculated for each combined 3-day intake. Serological and hematological analyses of blood were performed. Dietary calculations indicated that intakes of calcium, vitamin B12, calories, and iron were lowest within the population sample. Blood analyses did not confirm the calculated inadequacies of dietary calcium, vitamin B12, or iron. Body weight data did not support the calculated inadequate energy intakes. Serum analysis indicated a folic acid deficiency. Mean intakes of energy and macronutrients were higher in nonblacks than in blacks; for most vitamins and minerals, the same was true. The lower calcium intakes among blacks than among nonblacks in the growing years exceeded the differential in energy intakes. Higher serum vitamin B12 levels in blacks than in nonblacks were observed but not explained.


Coexistence of Hodgkin's disease and Gaucher's disease. A case of Hodgkin's disease associated with long-standing Gaucher's disease is presented and compared with the only previously reported case. The two diseases coexisted in lymph nodes both above and below the diaphragm, liver, bone marrow, and pancreas. The question of a possible relationship of the two diseases is discussed.


Acute lobular (membranoproliferative) glomerulonephritis with hyperuricemia and obstructive uric acid nephropathy. Obstructive uric acid nephropathy, a potentially lethal complication of acute  renal failure due to glomerulonephritis, is described and illustrated. The factors leading to its occurrence and the reasons it may be undetected are detailed. Lobular glomerulonephritis is also briefly defined once again.


Isolated lymphoid hyperplasia of the bone marrow simulating malignant lymphoma. Lymphoid hyperplasia of the bone marrow occasionally resembles malignant lymphoma and may lead to confusion in bone marrow interpretation. The case of a patient with an unusual variant of isolated bone marrow lymphoid hyperplasia in which histologic overlap with lymphoma was found is presented. The case illustrates the difficulties in bone marrow interpretation that lymphoid hyperplasia can present. One cannot always rely on the number, size, or general pattern of lymphoid nodules to determine whether a lesion is benign or malignant. We suggest that when isolated lymphoid hyperplasia is composed of mature lymphocytes and confined to the marrow, a diagnosis of malignant lymphoproliferative disease should not be made.


Serum chloride analysis, bromide detection, and the diagnosis of bromism. Current methods for determining serum chloride concentration vary in specificity. Laboratory detection of bromide in serum is usually dependent on spuriously high chloride values. In the absence of historical information, the chemical identification of bromide in serum may be the only diagnostic sign of bromism. Bromide may be found in as many as 1% of sera obtained from inpatients of a general hospital. Ion-selective electrodes and some thiocyanate methods for chloride analysis can be highly sensitive to bromide (interference). Chloride electrodes are also sensitive to iodide.


Bleeding times, platelet adhesion, and aspirin. The effects of aspirin on well-standardized commercially produced platelet adhesiveness devices and template bleeding times were simultaneously studied in 19 normal volunteers. As expected, there was significant prolongation of the bleeding time after aspirin, but there was no change in platelet adhesion. Reason for the different effects of aspirin on the two tests are discussed. In addition, the normal range of platelet adhesion was further defined utilizing commercially prepared glass-bead columns.


Transferrin loss into the urine with hypochromic, microcytic anemia. Anemia developing during the course of chronic renal disease is a frequent complication often necessitating periodic transfusion therapy. A number of etiologic factors have been implicated, including decreased production of erythropoietin; decreased erythrocyte life span secondary to uremia and splenomegaly; increased bleeding tendency due to platelet dysfunction; and acquired lack of folic acid and iron. This paper concerns the problem of acquired hypochromic, microcytic anemia secondary to heavy urinary loss of iron and transferrin in a child with the nephrotic syndrome. The patient had microcytic, hypochromic anemia with serum iron, 12 mug. per dl. and a serum iron-binding capacity of 12 mug. per dl. There was no evidence of major bleeding resulting in a chronic hemorrhagic anemia. Urinary iron was 64 mug. per dl., with a urinary iron-binding capacity of 366 mug. per dl. Renal biopsy showed mesangio-proliferative glomerulonephritis. Evaluation of any patient with the nephrotic syndrome should include careful analysis of the various serum and urinary proteins and determination of serum and urinary iron and iron-binding capacity. This information would offer a more precise evaluation of the underlying cause of anemia in the nephrotic patient who may develop urinary loss of iron and transferrin and subsequent hypochromic, microcytic anemia.


The effect of thrombocytopenia on the determination of platelet aggregation. Platelet aggregation has been widely assumed to be unmeasurable in thrombocytopenic samples. Using a sensitive differential self differential self-calibrating aggregometer, and standard aggregating agents, aggregation was measured in serially diluted platelet-rich plasma. Aggregation induced by ADP or collagen was reproducible at platelet counts as low as 50,000 per cu. mm., and with epinephrine aggregation was reproducible at platelet counts as low as 75,000 per cu. mm.


The primary pulmonary lymph node complex of crytptococcosis. A cryptococcal primary pulmonary lymph node complex has been demonstrated at autopsy or after thoracotomy in 1% of the cases of cryptococcosis. Stepwise microscopic examination of hilar lymph nodes should reveal a more frequent incidence of this rare but now well-documented complex. Nine examples of the cryptococcal complex are extant, including three herewith reported from the files of the Armed Forces Institute of Pathology. Four of these complexes developed in apparently normal persons and five in those hypersusceptible to infection because of neutropenia, diabetes, renal insufficiency, or corticosteroid therapy. The complexes in the normal persons were circumscribed granulomas and represented first-infection cryptococcosis similar to first-infection tuberculosis. There was a chronic course and a good prognosis with surgical resection. The complexes in the compromised hosts were predominantly acute diffuse pneumonias and large diffuse lesions of the lymph nodes, and were interpreted as first-infection cryptococcosis with massive spread facilitated by the compromised state. All these compromised patients died within a few weeks.


Computerized axial tomography of craniofacial malformations. A preliminary report. Computerized axial tomography is a new radiologic technique that permits noninvasive study of the skull, brain, and cerebral ventricles. This technique has been applied to the study of craniofacial malformations prior to intracranial surgical correction. The assessment of the cerebral ventricles is valuable as a base line study as well as helpful in detecting unsuspected abnormalities in the brain prior to surgery.


Behavioral disturbances among failure-to-thrive children. The eating, sleeping, elimination, autoerotic and self-harming behavior of 19 preschool failure-to-thrive children was studied. Their behavior was compared to a group of 19 children growing normally for their chronological age. Information was obtained by repeated home visits by public health nurses. The growth-retarded children had more feeding difficulties as infants, had skimpier, less regular meals, and had poorer response to food when rated on a five-point scale. Their daily caloric intake was lower. There was no substantial differences between groups for sleeping, elimination, autoerotic, and self-harming behaviors when each area was separately analyzed. However, when all the disturbances were summed, there was clear evidence that the failure-to-thrive children had a noticeably greater number of abnormalities than the control group.


Growth of previously well-nourished infants in poor homes. Twenty-six infants from very poor families were assured adequate diets in protected environments to average age 17.6 months. Ten female infants' mean length reached the tenth percentile and sixteen males' the 25th; female infants' mean weight nearly reached the 50th and males', the 75th. "Norms" in similar environments are near the third percentile for length and the tenth for weight, from infancy through childhood. Six months after returning to original homes there was no further growth in length or head circumference and a mean weight loss of 800 gm, thus declining to environmental norms. Growth followed these patterns until 4 to 8 years of age. Head circumference paralleled linear growth. In very poor environments, nearly maximal growth during the first two years of life apparently does not protect against the characteristic stunting, which may represent an appropriate adaptation.


Well-child care by pediatric nurse practitioners in a large group practice. A controlled study in 1,152 preschool children. A controlled two-year study of the effectiveness of well-child care by pediatric nurse practitioners (PNPs) of 1,152 children, newborns through age 22 months, was made at the Kaiser-Peranente Medical Centers in San Francisco and Oakland, Calif. In this setting of a large, prepaid, group practice health care plan, the PNPs were found to be entirely competent in maintaining the health of their patients, and were generally accepted by the parents. Effects on utilization of medical care facilities were minimal. Costs of well-child care were reduced.


Berkson fallacy revisited. Spurious conclusions from patient surveys. Clinical surveys of "selected" convenient patient samples (hospital or clinic) can lead to spurious conclusions unless the relationship of selected patients to the source population is carefully controlled. The possibility of biased conclusions from uneven selection rates of patients is called Berkson fallacy. Studies of cerebral palsy and low birth weight provide clear examples of Berkson fallacy. A fictitious clinical survey of cerebral palsy and low birth weight is presented to illustrate how Berkson fallacy may lead to interesting but spurious conclusions from patient surveys.


Childhood polymyositis with cardiac conduction defects. Pediatric polymyositis may be an entity distinct from dermatomyositis. Chronic polymyositis can occur in childhood and, as in adults, may be associated with arrhythmias. Microscopical involvement of the myocardium and pericardium in dermatomyositis is probably far more common than suspected on clinical grounds. Cardiac evaluation is suggested for all children with dermatomyositis or polymyositis, particularly prior to surgical procedures. Intracardiac electrographic recording techniques offer improved accuracy in determining the site of cardiac conduction defects, and may aid in planning for the use of antiarrhythmia medications or a pacemaker. In children with dermatomyositis or polymyositis known cardiac stimulants should be administered with care.


Acute athetosis as a result of phenytoin toxicity in a child. A case of acute athetosis in a child was found to be related to phenytoin toxicity. Symptoms were intermittent and coincided with drug administration. More common toxic effects were not noted on initial evaluation of the patient.


Torsion of a visceroptosed spleen.

Torsion of a visceroptosed spleen. Torsion of the pedicle of a visceroptosed spleen, a rare condition, was diagnosed preoperatively in a 4-year-old girl, with the aid of history, physical examination, blood smear findings, splenic scans with technetium Tc 99m sulfur colloid, and selective angiography. A splenectomy was performed, and the child made an uneventful recovery. This case report illustrates some of the diagnostic and therapeutic considerations pertaining to torsion of the spleen.


Variola minor in Bragança Paulista county, 1956. Attack rates in various population units of the two schools including most students with the disease. Overall attack rates were different for the two schools but were the same when only classes with cases were considered. Of the 49 classes (from both schools) with susceptible students, 29 had cases. In these, the attack rate among susceptibles ranged from 4-69%. The differences between the class rates were highly statistically significant. In the José Guilherme School, 17 out of 21 classes containing susceptibles had cases as compared with 12 out of 28 classes in the Jorge Tibiriçá School. Attack rates differed little between schools for either the early or late shift classes, but the attack rate for early shift classes in both schools together (39%) significantly exceeded that for the late shifts (16%). Within-shift attack rate differences were highly significant for the first-shift classes but not significant for classes in the other shifts. Attack rates differed significantly by classroom population (group of students using a classroom including all shifts), mainly because of heterogeneous rates in one school. Attack rates by desk column did not differ significantly even when comparing the column seating the earliest, the latest or the "previous" case in the class with the remaining columns. Attack rates by desk row also did not differ significantly. There was no important progressive association between attack rates and size of "unit of susceptibles" (group combining columns and rows), but there was a significant difference for unit size. Attack rates were not influenced by cluster seating of susceptibles.


Some bacteriologic aspects of the epidemiology of pulmonary and extrapulmonary tuberculosis. A study was carried out to investigate the drug resistance patterns of the prevalent tubercle bacilli in pulmonary and extrapulmonary tuberculosis in and about the city of Lahore, Pakistan. This report includes 168 strains of Mycobacterium tuberculosis isolated from the same number of pulmonary tuberculosis cases (100 untreated cases, defined as patients either having no history of anti-tuberculous therapy or having had chemotherapy for not more than 10 days; 68 treated, defined as having had chemotherapy for more than 10 days), and 162 strains from the same number of extrapulmonary tuberculosis cases (77 untreated, 38 treated and 47 doubtful). The proportion method of drug susceptibility assay was employed. According to the procedures used in this study and with 1% as the critical proportion for resistance, bacterial resistance was found to be very prevalent in pulmonary tuberculosis. Even among those cases in which no history of previous treatment was elicited, 46% were found to be excreting populations of tubercle bacilli having some degree of resistance to one or more of the primary drugs--isoniazid, streptomycin and para-aminosalicylic acid. In treated cases, 86.8% were found to have some resistance to one or more drugs. Overall, resistance to streptomycin was found to be commonest. Drug resistance was observed to be somewhat less common in extrapulmonary than in pulmonary tuberculosis, with streptomycin resistance predominating. Although both catalase-positive and catalase-negative isoniazid-resistant strains of M. tuberculosis were isolated from patients with pulmonary disease, no catalase-negative strains were isolated from patients with extrapulmonary disease, suggesting limited pathogenic potentialities of catalase-negative strains for man. Epidemiologic aspects of these observations are discussed.


Background of angina pectoris: social and environmental factors in relation to smoking. Questionnaire data on about 1200 male twin pairs from the Registry at the Karolinska Institute, Stockholm, and on about 4000 male twin pairs from the Registry of the National Research Council, Washington, DC, have been used to study factors affecting angina pectoris. An operational definition of "angina pectoris" was developed from the questionnaire. In the available data, alcohol drinking, lack of exercise, frequent change of employer, low occupational adjustment and smoking are moderately but significantly related to angina among individuals (disregarding twin relationships) in both Sweden and the US. In monozygous US twin pairs discordant for the above variables, significantly different rates of angina appear only with alcohol drinking. In discordant dizygous US twin pairs, significantly different rates of angina appear with alcohol drinking and with low occupational adjustment. Of the independent variables only smoking and drinking are appreciably associated with each other. These findings suggest that alcohol drinking and to a lesser extent occupational adjustment are related to angina directly and not through their association with other factors such as age, genetic background, smoking, physical exercise and early environment.


Cigarette-smoking and nonfatal myocardial infarction: rate ratio in relation to age, sex and predisposing conditions. The relationship of cigarette-smoking and nonfatal myocardial infarction (AMI) was evaluated using the case-control approach. Overall, the association was present for smokers of one and two packs per day, the standardized rate-ratio estimates being 1.5 and 1.7, respectively. The association was strongest in those who had a low risk score for AMI and particularly strong for people in the earliest (fifth) decade of age. People with diabetes and/or angina manifested no association between cigarette-smoking and AMI.


A comparison of four methods for determining prevalence of induced abortion, Taiwan, 1970-1971. A methodological study of four procedures for obtaining information about induced abortion was done in Taiwan in 1970 and 1971. About 2000 women were in a repeat interview group and seen every six weeks for nine rounds; one-half of these were also asked to provide urine on each round for a pregnancy test. Another 2000 women were interviewed only once; about one-half were asked "standard" knowledge, attitude, and practice questions about their reproductive history, including abortion. The other one-half were asked the same questions except they were not queried about their practice of abortion, but rather were asked to participate in the randomized response technique (RRT). Three methods produced estimates that 13-14% of the women had had an induced abortion. The RRT gave a significantly higher estimate, 28%. All methods used were judged feasible, although there is a suggestion that, without some improvement, the RRT may be difficult to use in low literacy populations. The repeat interview did not demonstrate advantage over the single interview in obtaining prevalence of women with a history of induced abortion. Ths use of a shorter interval with probing when the pregnancy test is positive might improve identification of recent abortions.


Serologic studies in 11,460 pregnant women during the 1972 rubella epidemic in Israel. A total of 11,460 women in the first 4 months of pregnancy, either exposed to or with suspected clinical rubella were tested for rubella antibody during an extensive epidemic of this disease in 1972. The proportion of women who were seronegative decreased from 25% at the beginning of the epidemic to 16% toward the end. In 542 (79%) of 682 cases with suspected clinical rubella, the laboratory findings were consistent with recent rubella infection, while in the remaining 140 cases of suspected clinical rubella recent infection could be excluded by serologic tests. CF tests were more useful than HI for confirmation of clinical rubella, and especially for retrospective diagnosis, since elevated titers (larger than or equal to 1:16) were suggestive of recent infection. Paired sera were tested from 4203 patients exposed to rubella: 1126 of the subjects were seronegative and the remaining 3077 seropositive (HI larger than or equal to 1:16) on first testing. In the seronegative group, 278 seroconversions were detected (24.6%): 247 cases of clinical rubella (21.9%) and 31 seroconversions without clinical symptoms (2.7%). Among the seropositive subjects in 2306 instances (74.9%) recent subclinical rubella could be excluded by low and stable HI or CF antibody titers in paired sera. In 32 (1.1%) an antibody rise (HI or CF) without clinical symptoms was detected, and in the remaining 739 (24%) high CF titers were found in paired sera, and these were classified as suspected subclinical rubella.


An extensive rubella epidemic in Israel, 1972: selected epidemiologic characteristics. An extensive rubella epidemic which occurred in Israel in the spring of 1972 provided an opportunity for several observations: 1) This epidemic had been preceded by another extensive outbreak in 1962. The interepidemic period was characterized by persistence of some rubella activity and occurrence of limited outbreaks at irregular intervals. 2) The crude annual attack rate based on the number of recorded cases among a 2,160,000 Sick Fund insured population was 315 per 10,000; this was about 5.4 times higher than the attack rate calculated from the number of cases reported to the Public Health Offices. In selected areas, where the medical personnel had been canvassed, the attack rate was 1,101 in a population of 19,131. 3) Highest specific attack rates were observed in the age groups 5-9 and 1-4, followed by the age group 10-14. 4) A slight predominance was observed in male cases aged 1-4 and female cases aged 20-24. 5) The peak occurred 1-3 months after the epidemic started, and stopped very quickly at the beginning of the summer, one month after the kindergartens and schools commenced the summer holidays.


Subacute sclerosing panencephalitis: an epidemiologic study in Israel. Subacute sclerosing panencephalitis (SSPE), a disease related to measles (rubeola) infection, was more common in Arabs and Sephardi Jews than in Ashkenazi Jews in Israel. There were no familial aggregates and it is unlikely that genetic differences account for this selectivity. Among several non-genetic factors which might explain the selectivity, family size emerged as a possible risk factor. Family size has not previously been suspected as influencing the risk of SSPE. Preponderance of SSPE in rural areas and among the poor would also be compatible with this idea as family size tends to be larger in rural and lower socioeconomic groups. In large families, there may be a greater change that older siblings will transmit measles to very young siblings. In small families, measles may be acquired from peers at about school age when risk of SSPE may be lower.


Brucella suis infection in Philadelphia. A survey of hog fever and asymptomatic brucellosis. Examination of hospital and public health records revealed 19 cases of brucellosis diagnosed in Philadelphia between 1968 and 1972. A serologic survey at Philadelphia's largest hog-processing plant, however, indicated infection in 39% of workers. If extrapolated industry-wide, the total would be several hundred in Philadelphia. The infection is usually unrecognized or asymptomatic, since men were active in physically demanding jobs with agglutinin titers in excess of 1:5000. Overt illness, usually first diagnosed after weeks of incapacity, responded readily to tetracycline therapy. Although clinical manifestations are nonspecific, attention to occupational history should quickly lead to the diagnosis. It is emphasized that any hog-processing plant, wherever located, is potentially a reservoir of brucellosis. Prolonged morbidity and loss of production time might be avoided if physicians were more alert to this infection. Agglutinins in possibly significant titers were also found in a small fraction of persons without identifiable exposure.


HL-A antigens in North American black families. The polymorphic HL-A histocompatibility system has been studied in North American black families. The family studies show that haplotype frequencies differ between black and white populations. Seven haplotypes (W28,W5; W28,W17; W28, undefined four; W23,W5; W19,W5; undefined LA,W5; and undefined LA, undefined four) were significantly more frequent in blacks than whites, while haplotypes 1,8 and 3,7 were significantly less frequent. Some of these differences may be accounted for by differences in gene frequencies between the two groups; other differences may be explained by linkage disequilibrium in the white population. No significant linkage disequilibrium between the LA and FOUR loci was found in the black population.


The Diego blood groups: a genetic linkage analysis. Data are presented which show that the Diego blood groups are not part of the Dombrock or Yt blood group systems and that the locus controlling Di is not closely linked to the loci controlling ABO, Fy, Jk, Kell, MNSs, Rh, Gm, Inv, AcP,ADA, PGD, and UMPK.


Nonrandom distribution of exchange points in patients with structural rearrangements. High resolution studies of structural rearrangements were carried out using the G-band technique. A total of 220 breakage points were identified within individual bands from 117 unrelated cases born with a structural rearrangement. Breakage points were not evenly distributed along chromosomes in terms of G-band patterns. There was an excess involvement of light bands and a striking lack of dark bands in both reciprocal translocations and inversions. In reciprocal translocations, the middle part of a chromosome arm has less chance of being the site of an exchange than the terminal and centromeric parts. The implications of these results are briefly discussed.


Biochemical and genetic studies of plasma and leukocyte alpha-L-fucosidase. Deficiency of alpha-L-fucosidase in plasma and leukocytes has been demonstrated in three patients affected with fucosidosis. The measurement of plasma fucosidase activity alone is of little diagnostic value. Several normal individuals were found to have extremely low plasma alpha-L-fucosidase activity, but normal activity in leukocyte preparations. The low plasma enzyme activity exhibited by clinically normal individuals appears to be an inherited characteristic. The plasma enzyme was found to be different from that of leukocytes in terms of electrophoretic mobility.


Evidence for "deleted" or "silent" genes homozygous at the locus coding for the constant region of the gamma3 chain. Three uncommon stable Gm haplotypes, Gm3;23;--, Gm1,2,17;..;-- and Gm1,17;..;-- have been transmitted through 3 generations of two related Lebanese and Syrian families. No pathological consequence was noted in seven individuals, aged 14--65, whose sera were deficient for all the allotypes carried by the IgG3 chains. Among the different genetic events which could have produced these haplotypes (alteration of a regulatory gene, point mutation, gene hybridization, gene deletion), it appears that a structural deletion is the most probable explanation. The observed data can be explained by either a partial or a total deletion of the constant portion of the IgG3 heavy chain.


Incidence of aneuploidy in a human population. A population of 40,371 individuals consisting of every baby delivered at two Denver hospitals from 1964 to 1974 has been screened from aneuploidy of the sex chromosomes and chromosome 21. The pattern in time with which aneuploidy occurs suggests an epidemic component of the incidence superimposed on an approximately equal constant frequency. The epidemic incidence is most likely to be high for births from May to October, to persist for several consecutive years, and then to be absent for several consecutive years.


Immunoglobulin allotypes in Sardinia.

Immunoglobulin allotypes in Sardinia. 1218 individuals from Sardinia island (Italy) were tested for Gm and Km markers; 10 were not tested for Gm and only 401 were typed for Am markers. The peculiar genetic makeup of the Sardinian population is confirmed by their Gm allotypes. Their differences from those found in a control population of continental Italy (Ferrara), suggest ancient contacts with the Middle East and Africa. An indication for such contacts may also be found in the striking presence of the haplotype Gm f;n;bsc5, a haplotype not previously found in a human population. A significant difference of G2m(n) allotype was observed between highland and lowland regions. If confirmed, it may suggest an adaptive pressure related to the CH2 region of the gamma2 chain, possibly due to endemic malaria in the past.


Admission procedures: A survey of current methodology. A survey was conducted by the Department of Medical Technology at Wayne State University to determine current admission procedures for student selection. With more applicants applying for clinical education than can be accepted, the selection process becomes critical. Questionnaires were sent to institutions throughout the United States with accredited programs in medical technology. Among the findings, trends indicate the use of grade point average, separate evaluation of science grades, use of an admissions committee, and a dependence on references and transcripts in selecting students. In addition, the study shows that in all the accredited programs surveyed, including universities, hospitals, Veterans Administration hospitals, and others, an average of 82 students apply each year for the 15 available positions, a ratio of 5.5:1.


A quality control program for analytical procedures using standard additions. A technique is presented which permits the rapid, simple quality control of analyses that are calibrated by the method of standard additions. The control program is based on the recovery of known amounts of added-in standard material, rather than the direct reading of instrument response.


Evaluation of an improved Reagent Strip system for measuring blood glucose. Using a new, synthetic whole-blood control and an improved reflectance meter, the within-run precision of Dextrostix Reagent Strips for quantitative determination of blood-glucose levels is compared with three common manual methods (hexokinase, o-toluidine, and glucose oxidase), and one automated method (neocuproine-AutoAnalyzer). In addition, the strip is compared on a day-to-day basis with the o-toluidine method. Dextrostix, used with the new instrument and control, provides results that compare very well with the other methods for within-run precision, and with the o-toluidine method for day-to-day results.


Preparation and storage of control slides for fetal hemoglobin determination by acid elution. To simplify the reading of acid eluted blood smears for fetal hemoglobin, positive and negative controls are placed side by side on a single slide. Red blood cells having high Hb F content are stained a bright pink in contrast to cells devoid of Hb F which appear as ghost cells with a faint pink outline. A method for preparing, fixing, and short-term storing of control slides with their subsequent room temperature acid elution and staining is given.


Evaluation of the Clinicard sulfobromphthalein procedure. As each new procedure has been developed by Harleco for the Instrumentation Laboratory, Inc. Clinicard Analyzer 368 instrument, the chemistry department at Americus and Sumter County Hospital has carefully evaluated the procedure and stistically compared it against the existing proceudre before the changeover was made. We have had excellent results with all but one of these procedures. This paper contains the results and the methods of statistical analysis used to compare the new sulfobromphthalein (SBP) procedure with our existing procedure. We found that the omission of a pre-injection specimen from the procedure to be used as a blank made a significant difference in results.


Evaluation of an automated coulometric back-titration analysis of bicarbonate. The bicarbonate module of the Stat/Ion was assessed in a clinical laboratory setting. Within run precision was evaluated by doing replicate analyses of patients' sera. Day-to-day precision was studied by making daily replicate analyses of buffered serum controls. The values for bicarbonate on the Stat/Ion were compared to Skeggs' method for determining carbon dioxide content on the AutoAnalyzer I. It was also compared to the value calculated from the pH and carbon dioxide pressure values obtained on the IL313-03 Blood pH/Gas system. Bilirubin interference was studied.


Comparison of the Coag-a-mate Dual Channel with the Fibrometer. The Coag-a-mate Dual Channel is compared with the Fibrometer in performance of prothrombin time (PT) and activated partial thromboplastin time (APTT) for commercial controls and patient specimens. The precision of duplicate APTT measurements was significantly better for the Coag-a-mate Dual Channel. However, the precision of duplicate PT measurement was not different between the two instruments. Although the Coag-a-mate Dual Channel did not offer any time saving on single measurements, analysis time was considerably reduced with batches of three or more samples.


Medical technology education II: Evaluation of a classroom-laboratory program. Data gathered on the graduates of the first three classes of the University of Colorado medical technology program student classroom-laboratory approach indicate that these graduates are successful medical technologists, although the program is nontraditional. The program includes lecture-laboratory sessions in a student laboratory setting with a shortened clinical education component. Questionnaires to evaluate 11 aspects of work performance were submitted to each graduate's immediate supervisor. Seventy-seven per cent of the evaluations were returned. Ninety per cent of those evaluated were rated as successful technologists (average performance or better). Following 7 to 12 months of job experience, graduates showed no significant change in work performance ratings. Therefore, using a classroom-laboratory setting prior to the clinical component appears to be an effective means of educating medical technologists.


Attitudes toward mentally retarded persons: effects of attitude referent specificity. The effects of the specificity of the attitude referent on female adults' expressed attitudes were studied. Specifically, attitudes towards "mentally retarded person" referent were compared with attitudes toward mentally retarded referents who were described in terms of their severity of retardation and CA. Results indicated that expressed attitudes toward a nondescript mentally retarded person referent were generally intermediate in favorability between mildy and severely retarded person referents. The response format of the attitude questionnaire (e.g., Likert, forced-choice) was also found to affect attitude scores differentially as a function of the referent employed.


Sexual knowledge and attitudes of institutionalized and noninstitutionalized retarded adolescents. Sixty-one noninstitutionalized and 60 institutionalized mentally retarded adolescents were psychometrically assessed on three measures: sexual knowledge, sexual attitudes, and self-concept. The two groups differed on total score on sex knowledge only, with the non institutionalized group being more knowledgeable. With regard to sexual attitudes and self-concept, the two groups did not differ in terms of total correct statements. Internal consistency demonstrated on all the measures ranged from .50 to .90. Intercorrelations of relevant variables for each group (10 for the noninstitutionalized, 13 for the institutionalized) produced several significant correlations. Results were discussed with reference to the development of a standardized instrument for assessing sex-education programs for mentally retarded persons.


Effects of restricted sampling on ITPA scaled scores. The Illinois Test of Psycholinguistic Abilities (ITPA) has received considerable attention as an instrument which can be used to assess and prescribe for individual learning problems. The ITPA was standardized on what was regarded as an "average" sample. One major criterion for determining "average" was an IQ between 84 and 116 on the abbreviated 1960 Stanford-Binet Intelligence Scale, Form L-M. In the present study, the effects of restricted sampling on the basis of IQ were examined, with the use of a simulation model. The results revealed that restricted sampling distorted certain derived scores, exaggerated mean dispersion scores, and made the analysis of individual profiles all but impossible. Restricted sampling was discussed in relation to the ITPA.


Responses to frustration: comparison of institutionalized and noninstitutionalized retarded adolescents and nonretarded children and adolescents. Thirty adolescents (10 institutionalized retarded, 10 noninstitutionalized retarded, 10 nonretarded CA-matched) and 10 children (nonretarded MA-matched) were individually given the Rosenzweig Picture-Frustration Study (Children's Form). Responses were scored for direction of blame and reaction type, yielding nine frustration response categories. Three of the nine response categories showed significant group relationships. Retardation, institutionalization, and CA were all found to have an effect on responding, although analysis of response profiles showed all groups to be very similar in response pattern.


Some interpersonal consequences of being mentally ill or mentally retarded. The present study was carried out at an institution for mentally retarded persons where the subjects (college students) were transported. Under the guise of being "normal," mentally ill, or mentally retarded, each of four confederates met three independent groups of subjects. The verbal reports of the subjects did not vary a great deal as a function of condition, but amount of pain inflicted in an experimental task was strikingly different. In the mentally retarded confederate condition, shocks delivered were shorter and less intense than those given in the "normal" or mentally ill confederate conditions. Since subjects had to teach the confederate, they might have been kinder in the mentally retarded confederate condition because less was expected of the learner. Evidence was also found suggesting that the social impact of stigmas depends on the personal characteristics of the stigmatized person.


Eyelid conditioning and intellectual level: effects of repeated acquisition and extinction. Groups of college students and moderately retarded persons averaging approximately equal age received eight alternating phases of acquisition and extinction trials with an electric pulse as the unconditioned stimulus for classical eyelid conditioning. The two conditioning groups did not differ significantly in attaining the acquisition criterion during any phase and showed systematic improvement in approaching the maximal rate of acquisition. However, the college students exhibited abrupt extinction in every phase, in contrast to retarded subjects. "Learning to learn" in the retarded group was more marked across acquisition than across extinction phases. Random control groups of the two subject classes displayed equal relative frequencies of nonconditioned blinks. Some of the findings clearly contradict a stimulus-context hypothesis of differences in learning rate associated with IQ level.


IQ, mental age, complexity, and trial blocks and the response latency of retarded and nonretarded children. The relationship between MA, IQ, complexity, and trial blocks on the processing performance of nonretarded and retarded children was examined. The main effect of trial blocks and an interaction between MA and Complexity were found to be significant. These results supported the conclusion that MA and not IQ is important for information processing.


Exploratory investigation of the ability of attendants to plan their own training program. A study was made of the ability of attendants in residential institutions for mentally retarded persons to plan an attendant-training program. A mailback survey of attendants in two midwestern institutions yielded 173 respondents. Planning-related responses were for originality, practicality, and completeness. Measures of job satisfaction, attitudes toward mental retardation, and demographic information were also obtained. It was hypothesized that the majority of attendants would be able to outline a training program for attendants and that planning ability would be related to the other variables measured. Tryon and Bailey's cluster analysis method was used, and four relatively independent clusters were found: rated training suggestions, job satisfaction, segregation-exclusion attitude, and tenure. An object-cluster analysis was performed on each attendant's cluster scores, identifying individual score profiles and isolating seven major 0-types. These were discussed in terms of predicted attendants' ability to plan a training program. It was concluded that some attendants are capable of making meaningful contributions to the training process but that this ability does not appear to be related to the other variables such as tenure or job satisfaction.


Social adjustment in more severely retarded, institutionalized individuals: the sum of adjusted behavior. A measure which is used to count kinds of social behavior in more severely mentally retarded residents was described in this study. The measure is an aggregate or sum, and it is referred to as the Sum of Adjusted Behavior. In this study, we determined measures of social adjustment which are useful for obtaining population parameters. Data concerning the relationship between the Sum of Adjusted Behavior and CA to MA, age at time of institutionalization, gender, medical diagnosis, medication, and social behavior were discussed. The relationships between adjustment and adaptive behavior were also defined on the basis of the findings.


Outerdirectedness in retarded children as a function of sex of experimenter and sex of subject. Effects of same- and cross-sex experimenters on attentive behavior and learning of 64 EMR children were examined in two conditions: experimenter not present (not in) or experimenter present and providing cues relevant to task mastery (relevant cue). A significant Sex of Experimenter X Sex of Subject interaction was found in the learning data, with girls performing significantly better than boys when the experimenter was male, the reverse pattern was evident, although not statistically significant, when the experimenter was female. Some effects were also found for individual experimenters. Although significantly more nontask orienting responses were observed in the relevant-cue condition, subjects in this condition performed as well on the learning task as did subjects in the not-in condition. Reversal trials showed greater glancing and superior performance in the relevant-cue condition.


Performance of MA-matched nonretarded and retarded children on measures of field-dependence. Thirty-four nonretarded and 34 EMR children, matched on mental age, were given three tasks relating to Witkin's cognitive style construct. The sample scores of the retarded subjects were consistently lower than the nonretarded subjects' sample scores on each test. The nonretarded children's performance aligned with Witkin's analytical, field-independent cognitive style in contrast to the retarded children's performance which was characterized by a more global, field-dependent style. The results were interpreted in terms of possible cognitive style differences.


Chromosome 11 long arm partial deletion: a new syndrome. Deletion of the distal end of the long arm of a chromosome 11 (11q-) was demonstrated by G-bands in a malformed 4.3-year-old girl. Comparison of her phenotype with those of the four previously reported cases of 11q-, three with a proven and one a presumed similar deletion, suggests that this defect results in a clinical picture most noticeable for the association of variable mental retardation, marked speech deficit, trigonocephaly, and pronounced growth failure.


Management of the hyperextended fetal head. Hyperextension of the fetal head in utero is readily detectable by roentgenography and ultrasound scan. Management is determined by presentation of the fetus. There are three types of presentations: face presentation, star-gazing breech presentation, and the flying fetus presentation. Undiagnosed hyperextension of the fetal head is frequently associated with cervical cord injury.


A comparison between gonadotropin radioimmunoassays with the use of 48 hour and six-day incubation methods. A double-antibody radioimmunoassay for human follicle-stimulating hormone (FSH) and human luteinizing hormone (LH) which can be carried to completion in 48 hours was compared with the conventional six-day double-antibody radioimmunoassay. The bound-over total (B/T) dose response curves for the 48 hour assay were comparable in slope and dose range with the six-day assay and the four per cent average within-assay and the nine per cent between-assay coefficients of variation for the 48 hour assay were comparable with the variation observed in the conventional six-day assay. Maximum variation among identical serum samples assayed in both systems was 15.3 per cent so that quantitative results obtained with either assay system were comparable.


The Copper T 220C: a new long-acting copper intrauterine contraceptive device. The Copper T(TCu) intrauterine contraceptive device (IUD) has been found to be an effective method of contraception but has the disadvantage of needing periodic replacement due to loss of copper through dissolution and fragmentation of the copper wire. Modification of the Copper T to overcome this disadvantage involved substitution of copper sleeves for wire on the vertical arm and the addition of copper sleeves to the horizonal arms to give an effective surface area of 220 sq. mm. of copper and an estimated life span of 20 years. A randomized comparative study was undertaken in 999 women to determine if the new model performed as well as the wire-wound Copper T 300. Net cumulative first-event rates at one year were as follows: TCu 220C-pregnancy 0.9, expulsion 3.7, removal for pain or bleeding 14.4; TCu 300-pregnancy 1.1, expulsion 3.1, removal for pain or bleeding 9.3. None of the differences in event rates were significant. If long-term follow-up confirms these findings, this new long-lasting copper intrauterine device could become the IUD of choice for all women.


Effect of clomiphene citrate on serum prolactin in infertile women with ovarian dysfunction. Serum prolactin (PRL) levels were determined by radioimmunoassay in 12 normal, menstruating women and in 26 infetile women with ovarian dysfunction for one cycle or for about 30 days in amenorrheic women. Galactorrhea was not observed. No significant change in serum PRL levels was observed throughout the normal, menstrual cycle. Of the 26 patients with ovarian dysfunction, seven showed PRL levels higher than normal. Twelve of the 26 patients were treated with clomiphene citrate (Clomid), 100 mg, daily for 5 days. Ovulation occurred in seven, and pregnancy was achi-ved in two of them. Serum PR;, follicle-stimulating hormone, and luteinizing hormone were measured for a preceding control cycle and during the cycle following Clomid treatment in the 12 patients. The serum PRL levels were normal during the control cycle in five of the patients who ovulated with Clomid and high in four patients who failed to ovulate. Although serum PRL levels were not significantly changed by Clomid in the patients who ovulated with the drug, they were markedly decreased during and immediately after Clomid treatment in patients who failed to ovulate with Clomid.


Diagnostic and therapeutic efficacy of cervical conization. Cervical conization was perfromed on 756 patients at the University of Kentucky Medical Center from July 1, 1964, to January 1, 1973. Sixty-six patients were pregnant at the time of conization. Eighty-six per cent of patients with cytologic findings of carcinoma in situ had histologic verification of carcinoma in situ or severe dysplasia, and there was absolute correlation between cytology and histology in 75 per cent of patients will occult invasive cancer. Cervical biopsies without colposcopic direction predicted either severe dysplasia or carcinoma in situ in 77 per cent of cases but were accurate in only seven of 24 patients with occult invasive cancer. Carcinoma in situ was present in 30 per cent of hysterectomy specimens following conization but recurred in only seven per cent of patients followed without hysterectomy. Recurrent carcinoma in situ following hysterectomy was more common in patients with residual intraepithelial cancer in the uterus but was independent of the size of the vaginal cuff removed. Major postconization complications requiring hospitalization occurred in 3.4 per cent of nonpregnant patients and in 7.5 per cent of pregnant patients.


Endometrial adenocarcinoma and the polycystic ovary syndrome. While endometrial adenocarcinoma is the second most common female genital malignancy, only four per cent of the cases occur in women  less than 40 years of age. The relative rarity of this disease in young women requires that we be especially attuned to those who are at high risk. This paper presents two case reports of women with polycystic ovarian disease who developed endometrial adenocarcinoma at 24 years of age. The pathophysiology ovarian disease and its relationship to the development of endometrial adenocarcinoma are discussed.


Effects of epinephrine on distribution of blood flow in the pregnant ewe. Seven pregnant ewes ranging from 85 to 140 days of gestation were infused with systemic doses of epinephrine and uterine arterial flow dose-response curves were determined. With a constant systemic infusion of epinephrine at a mean rate of 0.29 +/- 0.03 mug/Kg.-min., and the radionuclide lebeled microsphere method to measure arterial blood flow, a 38.5 per cent decrease in total uterine arterial blood flow was demonstrated while systemic pressure was unaltered. At this dose the reduction in endometrial blood flow was significantly greater (-58.7 per cent) than that in either the myometrium (-36.9 per cent) or placental cotyledons (-34.5 per cent) (p less than 0.025 and less than 0.005, respectively). There also occurred a decrease in blood flow to the mammary gland and the pancreas, whereas increased in blood flow to the skeletal muscle, adipose tissue, and spleen were documented. It is evident from this study that during the period of ovine pregnancy investigated, the vascular bed of all tissues comprising the pregnant uterus, including the placental cotyledons, are sensitive to the vasoconstrictive effects of epinephrine.


Termination of midtrimester pregnancy by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha. Midtrimester abortion was successfully induced in 117 of 120 patients with serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha (15-me-PGF2alpha). The mean abortion time was 14.12 hours, and parous patients aborted in a mean of 12.85 hours-significantly faster than nulliparous patients who aborted in a mean of 15.24 hours. Ninety-four per cent of the 117 successfully induced abortions occurred in less than 24 hours and 46 per cent in less than 12 hours. Uterine activity was monitored and analyzed in nine patients. Uterine response to a single intramuscular injection of 100 mug of 15-me-PGF2alpha was characterized by the appearance of low-amplitude, high frequency contractions and a rapid increase in baseline intrauterine tonus. A high level of uterine activity, 900 Montevideo Units, was observed within 30 minutes of the first intramuscular injection of 15-me-PGF2alpha. This activity was not maintained and decreased by approximately 30 per cent at the time of the second injection at 1 hour. It was not until 6 hours of 15-me-PGF2alpha therapy that activity stabilized at approximately 500 Montevideo Units. Even though all patients were premedicated with antiemetic and antidiarrhea agents, 68 of 120 patients experienced gastrointestinal side effects related to the 15-me-PGF2alpha administration. Vomiting was the most prevalent side effect, occuring in 65 patients, but the episodes were not severe, were well tolerated by the patients and did not necessitate the termination of prostaglandin administration in any of the patients. In this study abortion was successfully induced between weeks 9 to 27 of gestation. It was observed that patients with gestations of 16 weeks or less aborted significantly faster than patients with gestations of 17 weeks or more, which indicates that this method is highly effective in the induction of abortion within the "gray zone", 12 to 16 weeks of gestation.


Effectiveness of certified nurse-midwives. A prospective evaluation study. A prospective evaluation study of the effectiveness of the services of certified nurse-midwives demonstrated that in a hospital setting the care of low-risk maternity patients provided by nurse-midwives was as effective as the provided by house staff physicians. A total of 438 low-risk maternity patients were studied. Selected outcomes pertaining to the prenatal period, labor and delivery, and early infancy demonstrated, with two exceptions, no significant differences. The two exceptions were: (1) overcompliance with appointment attendance was more common among the nurse-midwifery group of patients; (2) a higher rate of forceps delivery was reported among the house staff group of patients.


Improvement of faculty teaching performance in a department of obstetrics and gynecology by student evaluation. The primary purpose of a faculty evaluation program is to upgrade the over-all quality of teaching and to identify the strengths and weaknesses of the individual teacher. Effective medical educators can thereby be suitably identified by objective and subjective criteria. Improvement of faculty teaching performance enhances student learning and can improve recruitment into our discipline.


Changes in evolution of free epinephrine, norepinephrine, and vanillylmandelic acid in the urine of rabbits during late pregnancy and parturition. The present study describes evolutionary changes in urinary excretion of epinephrine, norepinephrine, and vanillylmandelic acid during pregnancy and parturition. Both the catecholamines and their metabolite were determined in 24 hour urine samples of rabbits from day 13 of pregnancy. During 13 and 28 days of gestation, urinary excretion of epinephrine was at its lowest value. As compared to normal rabbits, an increase of 135 per cent in epinephrine excretion during day 30 of pregnancy was observed. Norepinephrine excretion reached its maximum level during day 13 but constant declines occurred afterward. Contrary to epinephine, urinary excretion of norepinephrine was at the highest value days 23 and 30 of pregnancy. After day 19 vanillylmandelic acid declined continuously up to day 30. During parturition vanillymandelic acid and norepinephrine excretion returned to the control values but epinephrine remained slightly higher. These alterations in catecholamine urinary excretion have been suggested as a consequence of modified endocrine and sympathetic activity.


Correlation between catecholamine content of the human Fallopian tube and the uterus and plasma levels of estradiol and progesterone. The content of catecholamines in the Fallopian tube and the uterus and the plasma levels of estradiol and progesterone were studied in cycling women. During the follicular phase norepinephrine levels were 33.4+/-7.1, 50.5+/-8.0, and 145.7+/-43.6 ng. per gram of wet tissue in the external, middle, and internal segments of the Fallopian tube, respectively. During the luteal phase norepinephrine content increased significantly in the external and middle portions (219.3+/-57.0 and 206.2+/-34.3 ng. per gram) whereas it remained unchanged in the internal one (185.2+/-53.6 ng. per gram). The NE content of the external and middle segments correlated significantly with plasma progesterone levels (r = 0.76 and 0.82, respectively, whereas oviductal epincphrine levels did not show significant changes as a function of the stage of the menstrual cycle. Uterine epinephrine content decreased by 67 per cent during the luteal phase whereas norepinephrine remained unchanged.


Hormonal studies in pregnancy. I. Total unconjugated estrogens in maternal peripheral vein, cord vein, and cord artery serum at delivery. The concentration of unconjugated total estrogens (primarily estrone, estradiol-17beta, and estriol) were measured by rapid radioimmunoassay method in serum samples from maternal peripheral vein, cord vein, and cord artery in normal pregnancies at delivery. The serum concentration of total free estrogens found in cord vein was four to five times higher than in maternal peripheral vein and cord artery. Levels obtained in maternal peripheral vein, cord vein, and cord artery were 47.8+/-1.8, 140.1+/-8.57, 31.8+/-2.15 ng. per millilitre (+/-standard error of the mean), respectively. These values are compared with those reported by others.


Patients at high risk for low-birth-weight delivery. A retrospective analysis of 8,839 singleton deliveries was undertaken to determine the relationships of maternal age, maternal hemoglobin concentrations, and past obstetric performance to the incidence of low-birth-weight (LBC) delivery. Patients under 19 years of age and patients with hemoglobin values less than 9.0 Gm. per 100 ml. were found to have significantly higher incidences of LBW deliveries. In addition, the incidence of LBW delivery was found to vary in proportion to the number of previous LBW deliveries and inversely with the number of previous term deliveries.


Amniotic fluid osmolality in pregnancies complicated by diabetes. Amniotic fluid osmolality (AF Osm) was studied in 247 patients whose pregnancies were complicated by maternal diabetes. Significant increases in mean AF Osm accompanied pre-existing fetal as well as subsequent perinatal death. Abnormal increases in AF Osm were associated with a significant increase in risk of perinatal compromise with cumulative morbidity and mortality rates of 54 per cent. These data suggest that serial evaluation of AF Osm enables detection of a "higher risk" group of diabetic pregnancies in which perinatal death is more than doubled.


Hyperfibrinogenemia and polycythemia with intrauterine growth retardation in fetal lambs. Plasma concentrations of albumin and fibrinogen and arterial hematocrits were determined during the last third of gestation in growth-retarded and control fetal lambs. The mean fetal plasma albumin concentration increased slightly as term approached and was not significantly different in the two groups. The mean plasma fibrinogen concentration did not change in the control fetuses, but was significantly elevated in the growth-retarded fetuses, as was the mean arterial hematocrit. The theoretical implications of these findings relative to capillary blood flow are discussed.