Treatment of cervical carcinoma.

Treatment of cervical carcinoma. A comparison of cervical carcinoma survived data is made between a large specialized cancer treatment center, M.D. Anderson, and a general regional medical center with 15,000 inpatient admissions and over 250,000 outpatient visits per year. End results are identical and did not depend on the percentage of time spent by the gynecologists or radiation therapists on problems of pelvic cancer.


Clear-cell adenocarcinoma of the vagina and cervix: survival data. Survival data on 36 patients with clear-cell adenocarcinomas are reported: seven with vaginal lesions and 29 with cervical lesions. Although the tumor responds to present treatment modalities, it tends to be associated with early lymph node involvement, thus making early diagnosis essential. Radiation as a primary therapeutic measure has often been followed by late recurrence, though many patients with these tumors were treated by older, low-energy modalities.


The age of occurrence of gonadal tumors in intersex patients with a Y chromosome. A total of 320 intersex patients with a Y chromosome were classified into four groups; (1) gonadal dysgenesis, (2) asymmetrical gonadal differentiation, (3) virilizing male hermaphroditism and (4) feminizing male hermaphroditism (testicular feminization syndrome). Of these 320 cases, 98 were from the files of The Johns Hopkins Hospital and the remainder from the literature. The incidence of tumors in relation to age and clinical classification was analyzed by computer. The results were plotted for each group. It was found that the percentage of tumors rose appreciably soon after the age of puberty in the first three groups, and it was concluded that the gonads were best removed before the age of puberty. In the case of testicular feminization patients, procrastination until the age of 25 could be considered, if one were willing to assume the risk of neoplasia of about 3.6 per cent until then.


Radiation exposure of ovaries during hysterosalpingography. Radiation exposure to an area approximating the location of the ovaries was measured in 29 patients undergoing hysterosalpingography. A thermoluminescent crystal technique was used for some patients; a pocket dosimeter placed into the upper vagina was used for additional patients. Radiation dosage varied from 75 to 550 millirads. The weight of the patient did not affect the amount of radiation delivered to the gonads. The duration of fluroscopic time was the major factor increasing dosage. A discussion of hysterodalpingographic technique and suggestions for decreasing gonadal irradiation during hysterosalpingography are included.


Motivation for licensure.

Motivation for licensure. This report is a chronicle of the activities that preceded and led to the licensure of occupational therapists in New York State. The activities began at the grass roots level with identification of problems that interfered with the delivery of occupational therapy services to patients in the Long Island area. Attempts to resolve these problems led to legislative monitoring and legal counsel. The end of the research era was marked by the wider involvement of the membership of the New York State Occupational Therapy Association required to secure the passage of licensure in New York State on August 11, 1975.


Mobilization of membership for legislative action. Background and structure of the New York State Occupational Therapy Association and the committees assigned to implement legislative procedures are explored, followed by a description of the methods used to mobilize the membership to secure legislation to license occupational therapists. Workshops were given to educate the membership in the legislative process and a communication system was set up among the members, state legislators, other health agencies, and special interest groups. Support of legislators for the licensure bill was solicited, as well as support from others contacted through the communication system. The members continued to solicit support and to monitor the progress of the bill during a two-year period. The bill was passed in August 1975. Based on their recent experiences with the legislative process. NYSOTA concludes that to secure licensure logical and judicious organization, education, constant feedback of information among participants, and hard work, determination, perseverance, and dedication of the group involved are necessary.


Licensure in Florida: the beginning of political involvement. This article presents a report on the licensure campaign of the Florida Occupational Therapy Association (FOTA) beginning with the organization of a licensure committee in November 1974 and ending with the governor's signature seven months later. The licensure campaign provided lessons that can be shared with other groups. It is recommended that the membership be educated and involved, that full consent be obtained from all occupational therapists in the state, that a lobbyist be hired, that compromise be anticipated and be possible, and that organizations seeking licensure be aware that this step is just the beginning of political involvement.


Ethics in conflict: yesterday's standards-outdated guide for tomarrow? Health care today is influenced by government controls, consumerism, malpractice litigation, unionism, and professionalism. Are there universal standards the serious health professional can or must accept, or should he formulate his own? In this paper, the sources of ethical criteria for occupational therapy are reviewed and assessed. It is recommended that a code of ethics for today be formulated for occupational therapy using the ethical principles proposed in this paper.


Cardiac and other abnormalities in the sudden infant death syndrome. Many victims of the sudden infant death syndrome (SIDS) have abnormally heavy cardiac right ventricles. The degree of this abnormality is directly proportional to: a) the mass of muscle about small pulmonary arteries, b) the amount of brown fat retention about adrenal glands, and c) the presence of hepatic erythropoiesis. The pulmonary arterial abnormality is probably the result of chronic alveolar hypoventilation, while brown fat retention and hepatic erythropoiesis are likely consequences of chronic hypoxemia. These abnormalities are found in both SIDS victims who die with and those who die without mild respiratory tract infections. However, there are some differences between the two SIDS groups. Infected victims die at an older age and have smaller thymus glands and larger spleens; there is a greater proportion of males in the infected victims than in the noninfected victims.


Long-term organ culture of embryonic rat pancreas in a chemically defined medium. Embryonic rat pancreas anlagen have been grown in a chemically defined medium, subdivided biweekly and recultured for a total time of 10 weeks. The total mass increment during this time was in excess of 1000-fold. Samples were removed for light and electron microscope examination and for periodic measurement of enzymatic activity. Morphogenesis and cytodifferentiation occurred, peripheral outgrowth of epithelial buds was followed by the formation of interconnecting tubular structures and, eventually, by the appearance of distinctive acinar cells with zymogen granules. Mitotic figures became conspicuous at the periphery of explants within a day after each subdivision resulting in the formation of new tubular structures and acini. In general, the central area of the explants presented more mature acini with zymogen granules than was manifested at the periphery. The enzymatic activities of amylase, lipase, and chymotrypsin developed maximally during the first week of culture, reached a plateau level by the second week, and remained at a relatively constant level throughout the 10-week culture period.


Quantitative ultrastructural study of the rat adrenal cortex in renal encapsulation-induced hypertension. Hypertension was induced in young rats by latex encapsulation of both kidneys. By the fourth week, 85% of the renal-encapsulated (RE) rats became hypertensive. Varying degrees of cardiovascular involvement were evident in the moderately to severely hypertensive rats. The level of systolic blood pressure was directly correlated with the width and the volume of zona glomerulosa of the adrenal cortex. Electron microscopy combined with morphometric-stereologic techniques was employed to quantitate change in the adrenal cortex. The cells of both zona glomerulosa and zona fasciculata of RE rats showed significant increases in the volume of the cell, nucleus, smooth endoplasmic reticulum, and lipid droplets; only in the zona glomerulosa cells was the increase in surface area of the smooth endoplasmic reticulum statistically significant. It is suggested that these structural changes associated with renal-encapsulation hypertension are related at least in part to stress of the hypertensive cardiovascular disease.


An evaluation of the role of leukocytes in the pathogenesis of experimentally induced corneal vascularization. III. Studies related to the vasoproliferative capability of polymorphonuclear leukocytes and lymphocytes. Studies in the past have suggested that leukocytes are a prerequisite to corneal vascularization. To test this hypothesis further, experiments were conducted to determine whether the intracorneal instillation of polymorphonuclear leukocytes, lymphocytes, or components of leukocytes would induce a corneal vascular ingrowth. These cells or cellular fractions were injected intracorneally into Fisher albino rats whose circulating leukocytes had been depleted by total body x-irradiation. Polymorphonuclear leukocytes isolated from glycogen-induced peritoneal exudates caused a corneal vascular invasion, but lymphocytes obtained from thymus, spleen, and lymph nodes failed to do so. To learn whether an extractable factor could be isolated from polymorphonuclear leukocytes these cells were suspended in isotonic saline, ultrasonified and then centrifuged at 101,952g for 1 hour. Aliquots of the resulting sediment and supernatant were injected intracorneally into rats with radiation-induced leukopenia. The nonsedimentable supernatant caused corneal vascularization, but the sediment did not provoke the phenomenon. These studies not only provide further support for the hypothesis that leukocytes initiate corneal vascularization, possibly by the release of one or more heat labile chemical mediators, but directly implicate the polymorphonuclear leukocyte in this process.


Enhancement of natural and experimental respiratory mycoplasmosis in rats by hexamethylphosphoramide. Hexamethylphosphoramide (HMPA) was given orally (100 mg/kg/day) to: a) conventional rats of Sprague-Dawley and Long-Evans substrains known to have indigenous Mycoplasma pulmonis infection, b) uninfected pathogen-free (PF) Fischer rats, and c) PF and axenic Fischer rats inoculated intranasally with M. pulmonis strains having a wide range of virulence. Treated rats infected with virulent M. pulmonis, either naturally or experimentally, developed severe clinical signs of murine respiratory mycoplasmosis (MRM) with mortalities of 25 to 60% compared to relatively mild MRM and no deaths in untreated, infected controls. Deaths were attributed to unusually severe lung lesions of MRM (extreme neutrophilic exudation into major bronchi and bronchiectasis) with ulceration of respiratory mucosa and hemorrhage. Rhinitis also was increased in severity by HMPA in conventional rats, but not in experimentally infected PF or axenic rats. Severity of otitis media and tracheitis was not affected by HMPA. Incidence of lesions of MRM was unchanged except for increased frequency of gross lung lesions. In the absence of M. pulmonis infection, HMPA treatment of rats caused thinning and microulceration of respiratory epithelium in major bronchi without inflammatory lung disease. Other effects induced by HMPA, with or without the infection, were destruction and fibrous replacement of olfactory epithelium, atrophy of testes, and reduced weight gains. It was concluded that HMPA markedly enhances both rate of progression and severity of the pneumonia while inconsistently potentiating the rhinitis of MRM in rats. Previous studies of HMPA are emphasized as an additional example in which the synergistic effects of an experimental chemical and an indigenous pathogen of laboratory rats have given misleading experimental results.


Quantitative microscopic evaluation of the endoplasmic reticulum in developing human liver. Quantitative electron microscopic aspects of the liver have not been explored in detail, and the numerical characterization of tissue changes may contribute to the understanding of basic cellular mechanisms in disease processes. Sixteen liver biopsies from children 2 months to 18 years old were analyzed by stereology to study the composition and relative distribution of endoplasmic reticulum membranes within hepatocytes. The histologic aspects of the liver as well as the clinical laboratory data of these patients revealed no abnormalities when being observed for suspected hepatic ailment. Morphometric analysis of four tissue blocks per biopsy was undertaken by means of combined light and electron microscopy, using standard stereologic formulae. The results showed less endoplasmic reticulum in liver cells from children 2 to 9 months old. These low levels were accounted for by reduced surface of smooth membranes. There was a first-order relationship in the growth of smooth endoplasmic reticulum between 2 months and 4 years at a rate of 17.1 sq cm/hr, similar to the membrane accumulation rate in experimental animals. Membrane dimensions from Golgi apparatus and rough endoplasmic reticulum were cell-size dependent, and these organelles matured within 2 months of postnatal life. The significance of these findings resides in the low amounts of smooth endoplasmic reticulum membranes at an early age. This lack of membrane surface agrees with findings in developing liver of various species. Experimental studies showed reduced membrane population and low microsome-bound enzyme activities which, under normal circumstances, allow the hepatocyte to undertake detoxification and drug metabolizing processes. Thus, the reduced membrane availability of the liver in infants may account for their inability to metabolize foreign compounds.


Achondrogenesis type I in three sibling fetuses. Scanning and transmission electron microscopic studies. Three spontaneously aborted fetuses with Type I achondrogenesis in a family with a first cousin marriage are described. Studies by light microscopy revealed abnormal cartilage, enchondral, and periosteal bone, and normal tooth development with abnormal alveolar bone. Electron microscopic studies of cultured skin fibroblasts manifested structurally normal cells. Scanning electron microscopy studies had shown deficient intercartilaginous septa in the metaphysis, with abnormally large calcifying globules. In the diaphysis, the orientation of bone trabeculae and collagen fibers within the trabeculae was disturbed. The numerous osteocytic lucunae were wide and irregular in arrangement and shape. Type 2 achondrogenesis, as studied in these fetuses, is probably a widespread mesenchymal defect, manifested by abnormal calcification and ossification of enchondral and periosteal bone.


Induction of chronic lethal Australia antigen hepatitis in mice. Clinically, idiopathic uveitis may be associated with chronic active hepatitis B. In searching for a possible cause of the uveitis in 6 patients having concurrent chronic iridocyclitis and chronic active hepatitis with serum Australia antigen (AA), the aqueous humor from each patient was analyzed for AA, passed through 220-mmu filters and inoculated directly into the livers of mice. The animals were observed for spontaneous mortality for 12 months, at which time the remaining animals were sacrificed. The livers of all animals were examined for hepatitis and AA. Although the aqueous humor from only 1 patient was found to contain AA, all six aqueous specimens produced a lethal viral hepatitis-like disease with liver AA. The results suggest that the six positive aqueous specimens contained a viral infection agent, which may have been the core of the Dane particle, and that the mouse is suitable for the laboratory investigation of Type B hepatitis by the technique described.


Kinetics of proliferation and differentiation in the hair follicle and epidermis in neonatally undernourished rats. Cell population growth kinetics of hair follicle and epidermis were measured in rats undernourished during suckling by increasing the litter size. Animals reared in litters of normal size served as controls. There was a marked atrophy of epidermis and hair follicles, and the thickness and length of the hairs were markedly reduced in the undernourished animals. Autoradiography following pulse labeling with 3H TdR demonstrated prolongation of the cell generation cycle. The G2 and S phases were chiefly affected, whereas the G1 was not altered. The double pulse labeling technique indicated a hold-up in the S phase in the epidermis, although the labeling index was not altered in the undernourished rats. On the basis of available literature, it is porposed that G2 is more energy dependent, whereas protein deficiency affects predominantly the S phase. Unlike the alteration in cell generation cycle, the process of differentiation--measured histochemically and on the basis of rate of migration of 3H-TdR-labeled bulb cells--appeared to be unaffected in undernutrition. However, there was a lag in the movement of cells out of the germinative zone. It is proposed that in undernutrition, cells spend longer time in the germinative zone to complete a critical number of division which may be peculiar to every tissue.


Social and emotional adjustment of infants and toddlers to a day care setting. Infants five to thirty months old were observed for one week on entering a day care program, and again at the end of one month. Frequency of behaviors reflecting social and emotional adjustment were recorded. There was significant decreases in frequency of crying, sitting alone, and interacting with adults, while interactions with other children increased significantly. Results indicate that children of this age can adjust well, and quite rapidly, to a day care setting.


The comparative predictive efficiency of intellectual and nonintellectual components of high school functioning. Much time is spent in elementary schools in assessment of cognitive attributes of children, little in measurement of noncognitive attributes. This study evaluates relative importance of early assessments of cognitive versus noncognitive variables as predictors of high school achievement and adjustment. Results demonstrate the critical, and frequently more important, contribution of the noncognitive attributes.


Child care attitudes and adaptation to the maternal role among mentally ill and well mothers. Discharged psychiatric hospital patients who were mothers of young children were compared with a group of well mothers on child rearing attitudes and adaptation to adult social roles. Mentally ill mothers were found to believe less in the importance of developing a reciprocal mother-child relationship or in differentiating between own needs and those of child, and were more likely to deny ambivalent feelings regarding child care. In each group, less adaptive child-care attitudes were related to greater impairment in adapting to other adult roles.


Maternal behavior and perceived sex of infant. Eleven mothers interacted with one six-month-old male infant, dresses either as a male or female. Differences were found in overall maternal stimulation and toy handling as a function of perceived sex of the baby. Mothers interviewed reported that treatment of their own infants was not differentiated by sex. Results indicate that mothers behave according to their expectations rather than infant cues, although unaware of their stereotyping.


A conceptual framework for evaluating human service delivery systems. Pressure on administrators, behavioral scientists, and others for program accountability is reflected in recent publication of a variety of theories, concepts, and methods of evaluation. This paper attempts to integrate pertinent literature, primarily from the behavioral sciences, into a comprehensive conceptual framework aimed at orienting administrators and others to the possibilities of evaluation, and suggesting variables appropriate to any organization or system.


Family planning during psychiatric hospitalization. Ongoing experience with development of family planning programs in psychiatric hospitals suggests that models must be flexible to allow for varying structures and traditions of institutions and for special needs of specific patient populations. However some issues, particularly those related to patients' rights and to usefulness of particular contraceptives, are broadly applicable. Introduction of a family planning program for psychiatric patients is described.


Assessing the empathic potential of student teachers of the emotionally disturbed. Two instruments currently used to assess empathic ability of teachers are examined and found to be inaccurate measures for teachers of the emotionally disturbed. It is noted that empathy in teaching is different from that in psychotherapy, and that adaptation of instruments used in therapy is inappropriate for educators. Suggestions for identifying the empathic teacher of disturbed children, and recommendations for developing measuring devices, are offered.


Stimulant drugs for hyperactivity: some additional disturbing questions. Continued professional recognition and concern are urged in regard to increased use of stimulant drugs for treatment of hyperactivity, unaccompanied by 1) adequate interdisciplinary communication about specific behaviors leading to referral and treatment, or 2) adequate assessment of the behavioral and educational consequences of the medication. Some pertinent questions are posed.


The effects of parental divorce: experiences of the child in early latency. This paper discusses the impact of divorce on 26 children in early latency, as observed shortly after the initial parental separation and one year later. The material is part of a larger clinical study, begun in 1970, of 131 children and adolescents from 60 divorcing families.


Antisocial behavior and social alienation post divorce: the "man of the house" and his mother. Women raising children alone after divorce often find their new socio-psychological world frightening and unmanageable. Perceiving this, their young sons may undertake a counterphobic defense of themselves and their mothers, manifested as antisocial behavior. Clinical experience outlined in this paper suggests that both mother and son can benefit quickly and dramatically from family interventions focused on recognizing and utilizing aggression.


Counter-transference and counter-experience in the treatment of violence prone youth. The constant confrontation inherent in therapeutic intervention with violence prone children, some of whome have committed homicide, is explored. Problems unique to work with these youths are discussed in terms of counter-transference issues for clinicians and counter-experience of teachers and child care workers. Suggestions for training and supervision are offered.


Behavior modification in a state mental hospital: a participant-observer's critique. Token economy behavior modification has become a popular and voluminously reported strategy for altering the behavior of patients in mental hospital back wards. This paper provides a qualitative, process view of one such token economy program. It reports subject perspectives, as well as interactions among experimenters, hospital staff, and patients. Questions are raised in regard to the overall effectiveness of such programs in alleviating the problems of mental patients.


Residential treatment of disturbed children and adequacy of their subsequent adjustment: a follow-up study. To study residential treatment outcome, a follow-up questionnaire sent to families of former child patients was used to assign them to categories of "good", "fair," or "poor" overall adjustment. The three groups were compared on variables such as presenting symptoms, duration of psychotherapy, amount of drug therapy, and prognosis on discharge; several therapist variables were also studied. Findings, some unexpected, are discussed.


Peer status and the directionality of symptomatic behavior: prime social competence predictors of outcome for vulnerable children. Social competence data from four target groups of vulnerable children--children of schizophrenic mothers; children of neurotic mothers; clinic children with externalizing symptomology; clinic children with internalizing symptomology--and from a large control group of their public school classmates, strongly suggest that peer-rated social incompetence and presence of externalizing behavior disorders are the best predictors of which vulnerable children run the greatest risk of poor adult outcome.


Aiding 'at risk' children through psychoanalytic social work with parents. A psychoanalytic social work approach to family intervention is described, and data on its impact on parents and their children are presented. Program parents, especially those in an open-ended approach, were rated as more positive both as persons and as parents; their children scored higher on IQ and other developmental and adaptational measures.


Comparison of an EMG-controlled prosthesis and the normal human biceps brachii muscle. An electromyographically-controlled elbow prosthesis, the "Boston arm", was tested with constant and sinusoidally-modulated inputs under different loading conditions. These tests were used to determine the frequency response of the EMG amplifier, the range of motor speeds, the force-velocity curve, and the frequency response of the prosthesis for cyclic movements. Human biceps muscle was tested during movements under similar loads, and under isometric conditions using random, electrical stimuli to determine its frequency response. The results were compared to evaluate the performance of the prosthesis and contrast its characteristics to those of the physiological system it replaces. The prosthesis minimizes quiescent power drain, and the possibilities of instability or "tremor" by employing velocity control, an overdamped mechanical system, and an electrical "dead-band". These factors limit the ability of the prosthesis to follow rapidly changing inputs or to move rapidly and accurately to a desired position. These comparisons should provide a useful supplement to the usual clinical evaluations, and a starting point for further improvements in prosthesis design.


Compact bone changes in cold-exposed rats. Rats exposed to cold stress show a reduction of relative cortical thickness in their long bones. The reaction resembles reduction of cortical thickness observed in Asiatic humans of the Mongoloid race, in whom many morphological features have been postulated to be cold-adaptive. However, until it can be established that the physiological processes underlying the experimental and phylogenetic condition are similar, no extrapolation can be attempted from the one to the other.


The dentition of the Indian Knoll skeletal population: odontometrics and cusp number. Data on the permanent dentition of 153 individuals from the well known Indian Knoll skeletal population are presented. Mesiodistal and buccolingual measurements were taken with a Helios dial caliper. Cusp number of maxillary and mandibular molars are recorded. The Indian Knoll dentition is larger than many modern groups but smaller than Australoid or Mesolithic groups. With the exception of maxillary 12, males have larger teeth than females in both dimensions. The lower canine is the most dimorphic tooth. Through rank order correlation, an association was shown between the sexual dimorphism of the mesiodistal and buccolingual dimensions. Compared to modern groups, the Indian Knoll population displays a moderate degree of sexual dimorphism in tooth size. In general, the coefficients of variation were greater for the more distal teeth within morphological classes. Amounts of size variability did not differ significantly between the sexes; moreover, rank order correlations indicated that patterns of variability in both dimensions were similar for males and females. The predominant cusp number pattern for upper molars is 4-3-3 and for lowers 5-5(4)-5. No sex differences were shown for cusp occurrence or bilateral asymmetry in cusp number.


Some observations on the dentition of an isolated group in northeast Poland. Clinical examination of the teeth and the mouth was carried out on a group of 133 "Old Believers," 54 males and 79 females, and a control group of 138 Poles living in the same area of Augostova in northeast Poland, 63 males and 75 females. Studying the frequency of Carabelli's cusp, shovel-shaped incisors, missing teeth, microdonita, supernumerary teeth, and torus palatinus in both groups, it was found that Carabelli's cusp and torus palatinus are more frequent among Poles. Such differences could be attributed to differences in ethnic origin of the two groups.


A survey of glucose-6-phosphate-dehydrogenase deficiency in the North Central Province of Sri Lanka (formerly Ceylon). A high frequency of the G6PD deficient gene was detected in the North Central Province of Sri Lanka. The frequency in the ancient villages is much higher than that of the recently colonised areas. The Sinhalese and Ceylon Moors have a significantly higher frequency as opposed to the Ceylon Tamils. The distribution appears to be related to a history of exposure to malarial endemicity.


The effect of sample attrition on the frequency distribution of blood pressure and genetic marker phenotypes representing a natural unselected community: Tecumseh, Michigan. High significant differences in mean age, blood pressure and phenotype frequency distributions between the non-migrants and "emigrants" of a total unselected community sample were discovered. Use of the mean of BP scores collected from epidemiologic surveys over a period of time as an individual score allows sample attrition to produce both a genetically and demographically biased sample of a population intended to represent an unselected community of people. Multiple regression analyses estimated the contribution of an individual's age, genotype and mobility out of the sample to predicting blood pressure variation. Variation in blood pressure means among certain marker phenotype classes was greater in those who leave than in those who stay, but only the upper portion of the pressure distribution contributed to this relationship. A genetic-environment interaction is suggested.


Factor analysis of body hair distributions. Using observations on the presence or absence of terminal hair in 13 locations on 700 white adult males, descriptive statistics were tabulated, phi coefficients of intercorrelation were computed, principal axis factor loadings were extracted, and varimax rotation of factors to simple structure was performed. The resulting rotated factors were interpreted as five independent components of body hair distribution: dorsal (less sacral), pubic extension, thoracic, sacral, and abdominal.


Archeology, population genetics and studies of human racial ancestry. Using traditional classification, many people have tried to determine the place and time of origin of the major human races. Two basically conflicting views have prevailed, one asserting that races developed as local variations in a species evolving phyletically over much of the Old World for up to one million years, and the other view holding that present races are local variations on populations recently expanding into most areas and replacing the previous hominid inhabitants, this occurring since the time of the Neanderthals. Both views are based on the same archeological data. Gene frequency data and time-calibrated genetic distance measures have recently been applied to this problem. Here we show that the probable demographic nature of Pleistocene populations has obscured genetic distances to such an extent that they cannot be used to discriminate between the two viewpoints of racial origins. The racial classifications themselves are probably not useful in this context and obscure the question, so that we presently do not have a scientifically valid understanding of racial origins.


Genetic structure of a tribal population, the Yanomama Indians. XIII. Dental microdifferentiation. Data are presented on the frequency of the following eight dental traits in 635 Yanomama and 65 Makiritare Indians: upper central incisor rotation or winging, shoveling of maxillary incisors, maxillary molar hypocone reduction, Carabelli's trait, mandibular molar cusp number, mandibular molar cusp pattern rotation of second lower premolar, and pattern of second lower premolar cusps. Yanomama dentition is unusual in the high frequency of six cusps on the mandibular molars. There is marked dental microdifferentiation between villages; significant agreement was observed between a matrix of pairwise "dental distances" based on six morphological traits and corresponding matrices based on 11 genetic systems and on geographic location.


ABO blood groups in Peruvian mummies. I. An evaluation of techniques. Blood groups of Peruvian mummies of known origin were determined by three different methods: agglutination-inhibition, induction of antibody production and mixed cell agglutination. The three techniques gave identical results, but the last two were useful in establishing the presence of H (O) antigen, while the first technique would not. The results indicate the presence of A, B, AB and O blood groups in America prior to known European contact. This suggests the need for a revision of concepts of blood groups in the American Indian.


Troop fission in free-ranging baboons in the Gombe Stream National Park, Tanzania. During a 13 month field study of baboons in the Gombe Stream National Park, Tanzania, the troop under observation divided into two groups. One group left the main troop to become ultimately an independent troop with a separate range. The troop fission followed a period of instability in the male status hierarchy. The events prior to and during the troop fission are described in detail and the membership of the group which left is analyzed. Social bonds prior to the fission, including kinship, determined membership in the group which left. Aggression from members of the main troop played a major role in causing the group which left to establish a new range. This fission is compared with troop fissions observed in rhesus and Japances macaques.


The effect of size variation on univariate assessments of morphological difference in human crania. The present research was undertaken to determine the contribution of general size to craniometric variation in two previously described Paleo-Amerindian series, and to evaluate the effect of size variation on univariate assessments of morphological difference between the two. The analysis was based upon 19 measurements of 81 crania representing the Iswanid and Fort Ancient Muskogid varieties. The results of principal components analysis indicate that the 19 measurements can be represented as five principal component variates. Inspection of component eigenvectors indicates that variation in body size accounts for 40% of the variation within the metric data. Analysis of covariance lends support to the hypothesis that this size variation contributes substantially to statistical tests of difference between the two groups based on Student's t.


Skin temperatures at the nape in infants at high altitude. Skin temperatures were measured on three Quechua Indian infants resident at 4,000 meters above sea level in Peru. Nape temperatures were warmer than other skin sites, suggesting that the brown adipose tissue associated with non-shivering thermogenesis is metabolically active despite the reduced oxygen availability at high altitude. The question of the role of non-shivering thermogenesis in infant thermoregulation under the covariant stresses of hypoxia and cold is still open.


The morphology of European and Southwest Asian Neandertal pubic bones. Descriptions of Southwest Asian Neandertal os coxae have stressed the supero-inferior flattening and acetabulo-symphyseal elongation of the superior pubic rami. Further analysis of Neandertal pubes, including two European specimens. La Ferrassie I and Krapina 208, indicates that Neandertal pubes are distinguished primarily by a relative elongation of the superior rami. The supero-inferior flattening of the pubic rami with the formation of a distinct ventral border, present among the Southwest Asian Neandertals, is less pronounced among the European Neandertals. Neither sexual dimorphism nor biomechanical hypertrophy appears adequate to explain this morphological pattern of Neandertal pubic bones.


An investigation of the postpsychotic depressive syndrome. Postpsychotic depression is an important clinical phenomenon about which little is known. Using data from a cohort of 30 schizophrenic patients, the authors examine the frequency of the syndrome, predictive variables, and its prognostic implications. Their findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.


Studies of superobesity: II. Psychiatric appraisal of jejuno-ileal bypass surgery. The authors studied 12 superobese women for 10 months to 3 years following jejuno-ileal bypass surgery. All patients had significant weight loss to near normal levels and were pleased with their newfound capabilities in the areas of physical, social, and sexual activities. Enhanced self-esteem, initiative, and assertiveness were noted. Although there were no serious postoperative psychiatric complications, patients experienced more mood lability and greater awareness of anxiety, depression, and irritability; their necessary adjustments in lifestyle strained relationships with spouses and parents in some cases. The principal drawback of the procedure was the occurrence in 7 patients of major somatic complications, with concomitant discouragement and apprehension.


The natural history of "chipping".

The natural history of "chipping". The authors present five case histories illustrating controlled use of opiates ("chipping"). Long-term chippers tend to develop consistent social use patterns that permit and also limit use. The authors conclude that controlled use of opiates is possible and that large numbers of people are involved in such use, although they are hard to locate and identify. Controlled users are differentiated from compulsive users more by their development and maintenance of social drug use rituals than by such variables as availability of the drug and personality and family background of the user.


Countertransference: a neglected subject in clinical supervision. As an acknowledged aspect of psychotherapy, countertransference would be an anticipated subject for discussion in clinical supervision. However, the authors' review of videotapes of 24 supervisors working with second-year residents revealed that 12 made no comments on the subject, 8 approached the subject directly, and 4 approached it indirectly. The authors discuss the reasons for this avoidance of countertransference issues and note that discussion of countertransference does not necessarily change supervision into therapy.


Treatment plans for mental health care.

Treatment plans for mental health care. The authors present a method for the development of standard process criteria for the care of defined subpopulations of psychiatric patients using a two-dimensional problem category system to describe patients. Patient subpopulations, described by both a traditional psychopathological problem cluster and a less traditional psychosocial problem cluster, are matched to a list of problem-solving services to develop a model treatment plan. The authors present this method for developing standard treatment plans as an alternative to APA's Model Criteria Sets.


Correlates of patient attendance in an inner-city mental health clinic. Of 140 patients seen at a psychiatric clinic serving a predominantly black, low-income population, 65% attended for four or more visits. Patients over age 30 and those with a diagnosis of psychosis or personality disorder remained in therapy for significantly longer periods than the rest of the group. Failure to prescribe medication was associated with early dropout, but this effect seemed to be attenuated with duration of therapy. The race of the patients and therapists did not seem to influence continuation in treatment, but such an influence may have been masked by differences in the therapists' experience.


Mental health services and the elderly: needs and options. The author examines mental health issues related to the elderly from the perspective of the options for immediate impact on treatment. He stresses the potential for creative collaboration between public and private mental health care systems. Myths, stereotypes, and misinformation about the aged are discussed, as are the positive. The author also describes an innovative model of service delivery in the treatment of older individuals.


Antiparkinsonian agents and fluphenazine decanoate. The author examined the incidence and severity of extrapyramidal symptoms (EPS) in 19 male psychotic outpatients receiving fluphenazine decanoate. Ten patients developed an EPS; only 3 had symptoms of the highest severity. The data suggest that neither prophylactic nor long-term use of antiparkinsonian agents is necessary for most patients receiving fluphenazine decanoate. On the basis of a comparison to a study of fluphenazine enanthate patients, the author concludes that fluphenazine decanoate is the drug of choice in terms of incidence and severity of EPS.


Thioridazine and sexual dysfunction.

Thioridazine and sexual dysfunction. The authors found a 60% incidence of difficulties in sexual functioning in 57 male patients who had taken thioridazine. Ejaculatory problems were the most frequent dysfunction; a third of these patients experienced retrograde ejaculation. The incidence of sexual difficulties in 64 patients who had taken other major tranquilizers was only 25%. None of the latter group experienced retrograde ejaculation-most had difficulty achieving and maintaining erection. The authors recommend consideration of the possibility of sexual dysfunction in patients given thioridazine.


Methodology and personality in Briquet's syndrome: a reappraisal. The authors describe a case of Briquet's syndrome in a man and discuss the relationship of that condition to personality features. They view Briquet's syndrome as a set of behaviors arising from personality traits and suggest that examination of the genesis and treatment of the condition be shifted to a characterological approach.


Editorial practices of psychiatric and related journals: implications for women. The author reports on the responses of 37 psychiatric and related professional journals to a questionnaire on procedures for selection of articles and of editors and/or editorial boards, with a focus on possible sexism in these practices. Results indicated little active effort to increase representation of women on editorial boards or in the authorship of journals, although existing practices were not necessarily discriminatory per se. The author hopes that this report will encourage more women to submit articles for publication and to seek active participation in the journals in their field.


Routine skull films in hospitalized psychiatric patients. Skull films were taken routinely for a sample consisting of all inpatients at a psychiatric facility over a 5-year period (N = 2,943). The skull series revealed some abnormalities in 17.3% of the patients and significant abnormalities in 2.4%. The author concludes that the results of this trial do not justify routine skull films for psychiatric patients in the absence of neurological symptoms.


Psychiatry and folk healing: a dichotomy? A mental health center's experience with folk healers in a Hispanic urban ghetto revealed a culturally accepted belief system based on a body of empirical knowledge that helps its members to cope with distress. The authors suggest that including folk healers as team members in the delivery of mental health services is a valuable contribution to psychiatry.


We help each other: primary prevention for the widowed. The authors describe the inception and evolution of a program of primary prevention directed at widowed men and women. The program has four major components-the widowed (telephone) line, home visits, social gatherings, and community seminars. The various roles that the counselor plays in the program are illustrated in a case report. An informal follow-up survey of 100 participants in the program revealed that the vast majority of those served felt the program was of benefit to them.


The role of natural radiations in human leukemogenesis. Some 3 billion years ago, life arose from a warm pool of primordial ooze amid a constant drizzle of radiation. Steadily, man evolved from the lesser forms of life because of or in spite of his natural background-radiation environment. This study is an attempt to determine to what extent these background radiations are responsible for human disease, namely leukemia. Dose rate data were compared with data on all forms of leukemia in the 50 United States for four population subgroups. For the total U. S., no relation between background radiation and leukemia is apparent. A positive correlation appears, however, if various states are deleted from the analysis. It appears that conditions relative to populations and their environment could mask a radiation effect if in fact one is present.


The use of nutritional 'positive deviants' to identify approaches for modification of dietary practices. The paper describes methodology for doing nutrition surveys among deprived population groups of grossly homogeneous socioeconomic status so as to identify those families in which a child between age six months and five years falls in the upper 25 per cent in height and weight measurements. These families are labeled as being "Positive Deviants" from the undernutrition that prevails in the population. They are then studied anthropologically to uncover any practices related to food sources, storage, preparation, consumption, and content. The information would be used in designing food supplementation or other nutritional promotion in the population at large on the assumption that the observed "favorable" practices, although atypical, are feasible and culturally acceptable because they are indigenously rather than extraneously derived. In addition, the survey collected data on fertility because of findings concerning the close interrelatedness among a woman's nutritional state, her age when first giving birth, intervals between births, and the growth and development of her young children. Severe undernutrition raised a woman's safe age threshold for first birth above 20 years and a reasonably safe birth interval to more than three years.


The epidemiology of drug use among New York State high school students: Distribution, trends, and change in rates of use. A two-wave panel survey was carried out on a representative sample of New York State public secondary school students in fall 1971 and spring 1972. The majority of adolsecents have drunk beer or wine (82 per cent) smoked cigarettes (72 per cent) or used hard liquor (65 per cent). Better than one third (35 per cent) report the use of one or more illegal drugs. The illicit drugs most frequently used are marijuana (29 per cent) and hashish (21 per cent). About one in eight adolescents have used pills such as amphetamines and barbiturates, and about one in 12 have tried LSD or other psychedelics. Four per cent have used cocaine and 3 per cent heroin. Use of illicit drugs tends to be experimental and sporadic rather than regular. By contrast, about one in four regularly use beer or wine or smoke cigarettes. Self-reported rates of use increase over the course of a school year, and there is considerable turnover with respect to which adolescents are users. The increased number of hard liquor and marijuana users through the high school years results predominantly from more stability among users, rather than increased conversion of nonusers to users over the teen years.


Public perception of ex-mental patients. Data are presented from two studies which show that perceptions of ex-mental patients appear to derive from a lack of information and that the provision of information alters the perception of former patients. Perceived unpredictability of behavior and dangerousness seem to form a dyad that causes the public to fear the mentally ill. More positive perceptions of mildly ill ex-mental patients were obtained when subjects were given short paragraphs describing typical behaviors and symptoms. These findings support the notion that a fear-motivated threat recoil cycle process is likely to be evoked by attempts to establish locally based treatment facilities, particularly in residential communities.


Hypertension detection and control in a rural white Kentucky community. This report presents data on the prevalence of elevated blood pressure and the status of hypertension control in a rural Kentucky community. Medical care is provided to the population under study by a long established organization of nurse practitioners. With the exception of young males, detection of hypertension has been relatively successful. However, fewer than 50 per cent of persons with blood pressure greater than 160/100 mmHg are receiving antihypertensive therapy, and greater than 60 per cent of individuals on therapy have blood pressure greater than 160/100 mmHg. Despite detection of hypertension control has not been achieved in this rural white community.


Peripheral vasopressin for safe and adequate control of portal hypertension during shunt operations. Nine patients with cirrhosis and portal hypertension were given intraoperative vasopressin (40 U/hr) in a continuous peripheral infusion during establishment of a distal splenorenal shunt. In all patients a significant and sustained reduction in portal venous pressure was achieved. As a result, blood loss during dissection and the time required for operation were minimized. The expected vasopressin-induced reduction in cardiac output was limited to a transient decrease at 5 minutes. There were no significant cardiac arrhythmias. These results suggest that vasopressin given through a peripheral vein during shunt operations is safe and facilitates dissection by providing significant and sustained reductions in portal venous pressure.


New approaches to the management of severe acute pancreatitis. A recent experience with seventy-seven patients admitted to Boston City Hospital for acute pancreatitis permitted us to identify thirteen patients (17 per cent) whom we diagnosed as having severe protracted acute pancreatitis. These alcoholic patients obviously had fulminant pancreatitis similar to that reported by others in two instances and pancreatic abscesses in two additional instances, but nine of the patients did not fulfill the criteria usually used by others as a basic for surgical intervention. Specific preoperative diagnosis was obtained in these patients by the aggressive use of endoscopic cannulation of the pancreatic ducts, which documented the presence of surgically correctable lesions. These patients had sustained significant malnutrition, which was corrected only by protracted therapy extending an average of two months and involving all modalities currently available for nutritional support of the severely ill patient. After proper preoperative identification of a specific lesion and correction of the malnutrition, the eleven patients without fulminant disease were operated on with no deaths or significant complication. Nine of the patients had elective procedures, which included six distal pancreatectomies and one total pancreatectomy. Thus, severe protracted acute pancreatitis can be identified, and once categrorized, it can have therapeutic implications.


Ablative surgery for necrotizing pancreatitis. We have confirmed again that bile and trypsin injected in dogs under high pressure produce highly lethal necrotizing pancreatitis responsive to fluid resuscitation. Animals undergoing pancreatectomy show a reduction in serum amylase levels and hemoconcentration (reflected in hematocrit levels) after pancreatectomy, an effect that may be related to removal of the source of vasoactive substances liberated in pancreatitis. Qualitatively, survivors of pancreatectomy exhibit accelerated convalescence. Pancreatectomy, however, does not increase survival once the disease process is established and may be harmful. This experimental study does not support the clinical use of pancretectomy but rather emphasizes the utility of adequate fluid resuscitation in the treatment of severe pancreatitis.


Treatment of postoperative reactive hypoglycemia by a reversed intestinal segment. Eleven men with disabling reactive hypoglycemia, in a range of 12 to 50 mg per 100 ml, were treated an average of seven years after gastric surgery with a 10 cm reversed jejunal segment. The reversal was placed at the gastric outlet in six patients and just below the ligament of Treitz in five. The former technic produced a somewhat better correction of hypoglycemia than did the latter. A good result was obtained in all eleven and none has had recurrence of seizures or fainting. Whereas the average minimal blood sugar before reversal was 34 mg per 100 ml, after reversal it was increased to 64 mg per 100 ml. The most severe hypoglycemia was noted in a patient after vagotomy and pyloroplasty. We recommend that all patients with dumping syndrome undergo glucose tolerance tests and plasma insulin determinations to ascertain whether they have reactive hypoglycemia. It is our conclusion that introduction of a reversed jejunal segment can control refractory reactive hypoglycemia resulting from previous gastric surgery.


Alteration in esophageal motility after laryngectomy. Ten laryngectomees underwent esophageal motility studies to assess the effect of laryngectomy on esophageal function. When these patients are compared with controls, marked derangements in esophageal motility were noted in the upper esophageal sphincter (UES) and in the body of the esophagus. Lower esophageal sphincter (LES) function did not differ significantly from the controls. Dysphagia developed postoperatively in five of the ten laryngectomees. This preliminary analysis suggests that esophageal motility disturbances may be relatively frequent after laryngectomy and that these disturbances may be clinically significant. The theoretical basic for the motility abnormalities and areas of future research are discussed.


Mortality and prognosis of obstructing carcinoma of the large bowel. In a series of 760 patients with adenocarcinoma of the colon and rectum, 103 patients presented with acute obstruction requiring urgent surgical decompression. Obstructed patients were slightly older and had slightly more advanced tumors than the total group. Obstructing lesions of the left colon treated primarily by staged procedures had relatively low mortality and five year survival figures comparable to unobstructed cases. Obstructing lesions of the right colon had a much poorer absolute five year survival rate, mainly because of the high operative mortality associated with primary resection in our institution. Five year survival after curative resection in patients with obstructing tumors of the right colon was considerably less than in patients with nonobstructing tumors. A suggestion is made for consideration of proximal external bowel decompression in association with resection of the right colon.


Fecal steroids and bacterial flora in patients with polyposis coli. Fecal neutral and acid steroids and bacterial flora have been studied in a series of patients with polyposis coli and normal controls. The patients with polyposis coli showed a higher concentration of cholesterol and primary bile acids, which increased still more after ileorectostomy. The bacterial flora of the patients with polyposis coli showed an anaerobe/aerobe ratio of 2.7/1 with a relative increase in clostridia and bifidobacteria and decrease in eubacteria and bacteroides. After ileorectostomy clostridia disappear, as do rumenococcus, peptostreptococcus, and fusobacteria, whereas eubacteria and lactobacilli decrease and bifidobacteria and bacteroides increase. Eubacteria showed a decrease from normal in the pre- and postoperative patients with polyposis coli and paralleled the reduction of cholesterol to coprostanol.


Effects of prophylactic antibiotics on colonic healing. The effect of antibiotic colon preparation on the tensile strength and morphologic appearance of colonic anastomoses has been investigated in dogs. Preparation with preoperative kanamycin did offer a slight benefit over mechanical bowel cleansing. The addition of erythromycin and kanamycin to the preoperative bowel preparation significantly (p less than 0.001) improved the mean tensile strengh of the healing colonic anastomosis. Continuation of erythromycin and kanamycin for one week postoperatively almost doubled the mean tensile strength of the healing anastomosis. Continuation of erythromycin without kanamycin in the postoperative period provided little protection over the preoperative administration of kanamycin and erythromycin. Histologic examination showed that erythromycin and kanamycin given during the pre- and postoperative period changed the mode of healing from that of secondary intention to healing by first intention. The findings support the concept that soilage of the peritoneal cavity at the time of elective colon surgery is not as important as leakage caused by poor anastomotic healing. Antibiotic bowel preparation with kanamycin and erythromycin improves the healing of colonic anastomoses.


Combined abdominotranssacral reconstruction of the radiation-injured rectum. Reconstruction of the rectum by a technic of combined abdominotranssacral proctocolectomy and proctocolostomy is presented as an alternative to the surgical conservatism that has been the time-honored approach to the management of radiation-injured rectum. The procedure has permitted safe accomplishment of rectal anastomosis with as little as a 1 cm distal rectal stump. Satisfactory, true anal sphincteric continence is  enjoyed by six patients who have been completely reconstituted, and satisfactory reconstitution in the remaining two is anticipated. These results suggest that reinspection of the traditional approach to the radiation-injured rectum is warranted now that safe and physiologically effective reconstitution can be accomplished by a combined abdominotranssacral technic.


Plasma and parathyroid tumor tissue gastrin and hyperparathyroidism. Hyperparathyroidism has been associated with an increased incidence of duodenal ulcer, increased acid secretion, and increased plasma gastrin levels. A relationship between these changes, increased serum calcium levels, and the increased incidence of peptic ulceration has been suggested, especially since increased plasma gastrin levels, serum calcium levels, and gastric acid secretion decrease after parathyroidectomy. We have previously suggested that the decrease in plasma gastrin levels after parathyroidectomy may suggest an extragastric source of gastrin, whereas others using immunofluorescent studies have suggested that the parathyroid adenomas themselves might be the source of this gastrin. We prospectively studied in fifteen patients with primary hyperparathyroidism, plasma gastrin and serum calcium levels before and after parathyroidectomy, as well as the gastrin content of parathyroid tumor tissue. The mean basal plasma gastrin level before operation was significantly greater than that of a control group and decreased insignificantly after operation, in contrast to serum calcium levels. No positive correlation could be found between plasma gastrin and serum calcium levels before and after operation. Parathyroid tumor tissue was assayed for gastrin content by radioimmunoassay and no detectable amounts of gastrin could be recovered from any tumor. The results do not support the concept that the extragastric source of gastrin in patients with hyperparathyroidism is the parathyroid adenoma itself.


Suppression of gastric secretion and serum gastrin by gastrin antibody. Fourteen dogs received varying doses of antigastrin antibody; after a single dose of 0.07 ml/kg, circulating gastrin levels could not be measured for as long as forty-seven days. Gastric secretion in response to food was not diminished by antigastrin antibody doses as high as 0.07 ml/kg daily for ten days. Larger doses, 0.2 and 0.4 ml/kg, were required to produce a temporary reduction in gastric-stimulated gastric acid secretion. Mucosal levels of gastrin in the antrum, fundus, and duodenum were greatly increased ten days after injection of antigastrin antibody. The therapeutic use of antigastrin antibody to control gastric secretion seems at the present time not feasible because of the scarcity of the antigastrin antibody and because large doses aare required to obtain only a temporary effect.


Human gastrin response to secretin after vagotomy. The gastrin response to a liquid meal with and without secretin infusion was studied in nine patients undergoing selective or truncal vagotomy with pyloroplasty for duodenal ulcer disease. Fasting gastrin levels were significantly increased in eight of nine patients after vagotomy, but secretin infusion did not consistently suppress these basal gastrin levels either pre- or postoperatively. Infusion of secretin did significantly lower the integrated gastrin response to feeding both pre- and postoperatively in eight of nine patients. Vagotomy alone did not significantly alter the integrated gastrin response to feeding. This data gives evidence that secretin infusion remains a helpful diagnostic test, differentiating those patients with recurrent ulcer and elevated gastrin levels postvagotomy from those patients with occult Zollinger-Ellison syndrome.


Gastritis and gastric blood flow in hyperdynamic septic pigs. The present study was designed to determine the gastric hemodynamics in a septic model that causes both a hyperdynamic state and acute erosive gastritis. Sepsis was established in twelve pigs by the intramuscular shank injection of Pastuerella multocida (42 X 10(8) colonies) in triptose phosphate broth; four pigs received sterile broth injections (shams) and eight received sterile saline injections (controls). After 18 hours, cardiac output was measured by both the cardiogreen dilution technic and the radioactive microsphere dilution technic; cardiac output was then compared to total and regional gastric blood flow measured by the raioactive microsphere entrapment technic. Acute erosive gastritis developed in septic pigs in the fundus and body of the stomach; the antrum was spared. Cardiac output was significantly increased in septic pigs compared with sham and control pigs. Total gastric blood flow and regional blood flow to the fundus, body, and antrum were also increased in direct proportion to the increase in cardiac output. These data suggest that acute erosive gastritis is primarily due to an end-organ cellular insult from sepsis and is not primarily due to a decrease or redistribution in gastric blood flow.


Neural control of blood flow in gastric mucosa. The innervation of the small vessels in the fundic mucosa of the rat and the effects of vagotomy on this innervation were studied ultrastructurally. The capillaries and arterioles, but not the venules, were found to receive direct innervation. Vagotomy causes degeneration of the nerve endings that innervate these vessels, confirming their vagal origin. This finding, and the fact that some morphologic changes in the capillaries were observed after vagotomy, provides morphologic evidence for the neural control of blood flow in the rodent gastric mucosa.


Rapid long tube intubation of the jejunum by a new endoscopic device. Despite the advantages of aseptic nonoperative intubation of the small intestine for decompression of obstructed loops, 48% of the attempts lead to failure to pass the tube through the pylorus. The difficulty and inconvenience of passage beyond the stomach have been overcome by the development of a special tube attachment adapted to a fiberoptic duodenoscope (Olympus Model GIF-K). Under direct endoscopic vision the tube can be carried into the second and third portion of the duodenum, released from the scope, and then further prodded into the jejunum. The entire procedure takes less than 15 minutes. Rapid intubation has now been easily carried out in five patients. Three patients had mechanical bowel obstruction. Rapid and effective decompression allowed adequate time for stabilization of concomitant serious problems such as (1) marked cardiopulmonary dysfunction secondary to a near fatal pulmonary embolus, (2) severe peritonitis post appendectomy, and (3) acidosis and dehydration. Surgical correction of the obstructing lesions was safely deferred for up to one week until the concomitant problems improved. The fourth patient, who was a renal transplant recipient, had chronic gastric ileus secondary to duodenal ulcer. Rapid passage of the long tube into the jejunum allowed restoration of nutrition and avoidance of gastrostomy. The fifth patient, with an ileus secondary to an infected abdominal aortic graft, underwent successful decompression but died of sepsis. He represents the only mortality. We propose that jejunal intubation using our technic is not only rapid but relatively easy and should encourage the wider acceptance of aseptic long tube intestinal decompression.


A possible explanation for postoperative diarrhea after colostomy closure. The transient diarrhea that sometimes follows the closure of colostomies has been ascribed to rapid transit in the previously defunctionalized distal colon. However, the present study of the temporarily bypassed colon in the rat indicated that a reduced capacity for the absorption of sodium and water develops within two to three weeks after bypass, without significant decreases in transit time or colon volume. After restoration of continuity, the absorptive capacity for water increased to normal under some of the experimental conditions. It is therefore suggested that postoperative diarrhea after colostomy closure in man may be related to a temporary decrease in absorptive capacity in the previously bypassed distal colon.


Analysis of patient disability after curative resection for colonic and rectal cancer. Ninety-seven patients undergoing curative resection for colonic or rectal cancer were investigated to determine the degree of early disability, that is, disability one to four years postoperatively. Seventy per cent of the patients were disability free postoperatively and fully employable, and among those who died of the disease, 73 per cent had no disability three months prior to death. The results indicate that waiting five years to determine cure in this disease wastes many man-years of fruitful employability.


Appearance and disappearance of multiply ciliated follicular cells during development of the dog's thyroid gland. Multiply ciliated follicular cells have been observed in developing thyroid glands in dogs. These cells are prominent three weeks prior to the expected date of birth but become progressively less common as development proceeds. After birth only rare isolated cilia remain. No evidence of removal of cilia by autophagy or loss into colloid was found. It is concluded that cilia are probably no longer formed by mature cells and that those already present are diluted out by progressive division of mature follicular cells.


The nonuniform distribution of acidic components on the human placental syncytial trophoblast surface membrane: a cytochemical and analytical study. The surface coat of syncytial trophoblast from term human placentas was studied using cytochemical methods (colloidal iron, alcian blue-lanthanum nitrate, dialyzed iron) in coordination with tissue enzyme digestions (trypsin, neuraminidase) and sialic acid analyses. The presence of at least two highly acidic anionic components that contribute significantly to the surface negativity of trophoblast has been demonstrated. The first of these, sialic acid, was removed with neuraminidase. Tissue digestion with this glycosidase was accompanied by a decrease in trophoblast surface staining with colloidal iron, a decrease in tissue sialic acid, and an increase in the concentration of sialic acid in the incubating medium. Results from methylation experiments were consistent with the presence of sialic acid. The second anionic component(s) was identified by removal with trypsin of a glycocalyx constituent that stained with both colloidal iron and lanthanum. After trypsinization, tissue sialic acid levels were not significantly different from control values, and no detectable sialic acid was present in the incubating medium. The identity of this anionic component has not been established. Both sialic acid and nonsialic acid acidic components are distributed in higher density on membrane of microvilli than on intermicrovillous surface membrane. In addition, the sialic acid moieties appear to be clustered in the glycocalyx.


Effect of uterine artery ligation on ovulation in the rat. Female rats were divided into six groups: (1) control, (2) one uterine artery (a.) ligated near the utero-tubal (U-T) junction, (3) one uterine a. ligated at the level of the cervix, (4) both uterine aa. ligated separately at the U-T junction, (5) both uterine aa. ligated separately at the cervix and (6) both uterine aa. tied with one ligature at the cervix. Segmental aa. were disrupted in all experimental groups except group 6. Animals were allowed to recover for ten days and killed the first metestrus thereafter. Number of eggs ovulated was determined by flushing the oviduct with saline solution and counting the ova. Control rats ovulated 5.0 +/- 0.4 eggs per ovary. Groups 2 and 3 had an increase in the number of eggs shed from the ovary on the non-ligated side. In contrast, a decrease in the number of ova shed occurred on the ligated side. When both aa. were ligated separately (groups 4 and 5), irrespective of location, a decrease in the number of eggs shed by both ovaries was evident. No effect was found when only one ligature was placed near the cervix (group 6). The data demonstrate that blood supply to the ovary via the uterine artery is essential for the full complement of eggs to be shed.


A macroscopic study of the brain of Bison bison bison, the American plains buffalo. The macroscopic anatomy of the brain of the American Plains Buffalo (Bison bison bison) is detailed herein for the first time. Many features vary significantly from most previously described ungulate species including its large size, fissural pattern of the cerebral hemispheres and well developed insular cortex. The midbrain, particularly the tectum, is outstanding: the superior colliculi appear to be the largest reported for any mammal and occupy most of the dorsal midbrain by surface area and volume estimates. The cerebellum is small relative to the total brain volume, a peculiarity reported elsewhere for other ungulates. Morphometric criteria further indicate the brain of bison is highly specialized. Drawing from various lines of evidence, it is suggested that the anatomical uniqueness of the present day bison brain may represent a vestige of the past, remaining largely unchanged over a broad expanse of geologic time.


Response of tanycytes of rat median eminence to intraventricular administration of colchicine and vinblastine. The effects of colchicine and vinblastine on tanycytes of the rat median eminence have been studied using the electron microscope. Colchicine and vinblastine were administered by intraventricular cannulation into the third ventricle and demonstrated distinct morphological effects on tanycyte microtubules. Highest drug doses administered were 50.0 mug in 5.0 mul of saline initially, followed by an additional 50.0 mug of these agents infused in a volume of 13.0 mul saline over an hour. Colchicine treatment resulted in the formation of large crystalloids within tanycytes, coincident with the disappearance of microtubules, all along the ventricular surface. Nonetheless the tanycytes appeared able to maintain a continuous, tight lining, as in controls, although some crystalloids were observed beneath the ventricular surface, either within tanycyte processes or within neuronal processes. Vinblastine treatment also resulted in the formation of identical crystalloids but at highest doses thoroughly destroyed the tanycyte lining of the median eminence and exposed cellular elements below the surface to the drug. Portal capillaries approaching the ventricular surface were generally free of any signs of drug response to either colchicine or vinblastine.


The familial incidence of allergic disease. The familial incidence of asthma, hay fever, recurrent rhinitis, recurrent bronchitis, eczema and urticaria was studied in 176 normal families. When these diseases, with the exception of urticaria, were present in a parent there was an increase in prevalence of the same disease in the child. This suggests that there is a heritable component in the end organ most easily sensitized in the allergic response.


Allergy and recurrent urinary tract infections in childhood. I. In pediatric practice urinary tract infections rank second in frequency only to infections of the respiratory tract. Evidence is presented that allergy of the urinary tract is a true entity and is commonly the initiating excitant of recurrent urinary tract infections. Specific antiallergic therapy frequently produces excellent results in these cases.


Airborne fungi survey: II. Culture plate survey of the home environment. The incidence of fungi found indoors and outdoors from 13 sites in the central and western United States is reported. Hormodendrum was the most frequently isolated fungus from all sites. Exposure from the more arid sites produced fewer fungal general than those from humid areas. Indoor exposures frequently produced more fungal genera than outdoor exposures.


Hemoconcentration and erythrocyte fragility in chickens exposed to heat and dehydration. Chickens were exposed to heat and dehydration, and the effects on their erythrocytes were examined. As chicken and camel (Camelus dromedarius) erythrocytes are of similar shape, the erythrocytes of the exposed chickens were compared with those of the camel. The salient findings were that chickens kept at 35 C without drinking water remained visibly unaffected. Their blood, however, showed hemoconcentration and increased erythrocyte osmotic fragility. Hemoconcentration could lead to an increase in body temperature of chickens in increased environmental temperatures.


Gastrointestinal trichomonads in horses: occurrence and identification. A survey of horses for gastrointestinal trichomonads was conducted to determine the organism's role in equine diarrhea and to establish its proper identity and morphology. Trichomonads were found by cultural examination of feces of 101 (35%) of 289 apparently healthy horses. At necropsy, trichomonads were cultured from 11 (37%) of another 30 horses which showed no signs of diarrhea at the time of death. In 4 of the 11 horses, colonies of trichomonads numbered 30,000 to 150,000/ml of cecal fluid. Diarrhea was induced in 1 of 6 horses, with the fecal fluid containing 10,000 to 110,000 trichomonads/ml. The trichomonad was identified as Tritrichomonas equi and it appears to be a normal member of the intestinal fauna of the horse. Its role as the etiologic agent of equine diarrhea is considered doubtful. The large numbers of T equi found in diarrheic feces are considered a response to, rather than a cause of, the fluidic environment of the gastrointestinal tract.


Treatment of horses with chronic diarrhea: immunologic status. All chronically diarrheal horses given (orally) 2 series of treatments with normal horse serum recovered in 2 to 4 weeks. However, mild diarrhea sometimes persisted several months in the group of horses with severe diarrhea. Weight gains were approximately 35% in horses with severe diarrhea and approximately 10% in horses with mild diarrhea. Serum specimens from 12 diarrheal and 20 normal horses were examined for immunoglobulins by single radial immunodiffusion technique. Concentration of immunoglobulin A in serum of diarrheal horses was approximately 50% lower than that in serum of normal horses. By contrast, there was more immunoglobulin G in serum of diarrheal horses than in serum of normal horses. Phytohemagglutinin (PHA-M) responsiveness of blood lymphocytes showed transient suppression during the stage of severe diarrhea. The regaining of PHA-M responsiveness of lymphocytes was observed simultaneously with the recovery process. However, the responsiveness of lymphocytes in recovered horses remained markedly lower than that in normal horses. Allergic reactions in diarrheal and normal horses were studied by observing dermal response to injections of saline extracts from some of the horse feeds. A delayed hypersensitivity reaction to streptokinase-streptodornase and PHA-M was also studied. Allergic reactions to these extracts were not induced in either diarrheal or normal horses; however, inflammatory response to the extracts was approximately 50% greater in normal than in diarrheal horses. Response to intradermal injection of either streptokinase-streptodornase or PHA-M was significantly greater in normal horses than in diarrheal horses.


Termination of pseudopregnancy by administration of prostaglandin F2alpha and termination of early pregnancy by administration of prostaglandin F2alpha or colchicine or by removal of embryo in mares. At day 24 of gestation, pregnant mares were allotted to 1 of 5 treatment groups (3 to 5 mares/group): group A--nontreated controls; group B--intraembryonic injection of 4 mg of colchicine on day 24; group C--removal of embryo on day 24; group D--subcutaneous injection of 1.25 mg of prostaglandin F2alpha (PGF2alpha) on day 32; and group E--removal of embryo on day 24 and subcutaneous injection of PGF2alpha on day 32. In all mares treated with colchicine (group B), the fetal bulge was absent within 2 days. The interval from injection of colchicine to onset of estrus was very short (mean, 4 days). These results indicated that treatment with colchicine was lethal to the 24-day embryo, and pseudopregnancy did not occur. Surgical removal of the embryo (group C) resulted in pseudopregnancy characterized by a prolonged interval from treatment to return to estrus (mean, greater than 31 days), prolonged production of progesterone, and prolonged maintenance of tense uterine and cervical tone. The interval from treatment to ovulatory estrus was longer (P less than 0.05) for group C mares than for group B mares. The mean interval from treatment to complete loss of tense tubular uterine tone was not significantly different between group A pregnant controls (28.3 days) and group C pseudopregnant mares (30 days). Treatment of pregnant mares (group D) with a single injection of PGF2alpha on day 32 resulted in loss of pregnancy in 4 of 4 mares within 2 to 5 days, and in all group D mares a large decrease in progesterone concentration occurred on day 33, 34, or 35. Although subsequent reproductive activity was variable, all group D mares rapidly lost the tense uterine and cervical tone characteristic of early pregnancy. These results indicated that a single subcutaneous injection of 1.25 mg of PGF2alpha caused loss of pregnancy, and pseudopregnancy did not occur. Treatment of group E mares, which had been made pseudopregnant by removal of embryo, with 1.25 mg of PGF2alpha resulted in termination of pseudopregnancy in 5 of 5 mares. All group E mares returned to estrus within 2 to 5 days after treatment, and progesterone concentration decreased (P less than 0.05) within 2 days after treatment. There was no significant difference in loss of tense tubular uterine or cervical tone between pregnant (group D) and pseudopregnant (group E) mares after PGF2alpha treatment.


Effect of bile acid on hepatic excretion and storage of bilirubin in ponies. Endogenous bilirubin uptake from plasma and biliary bilirubin excretion were determined in ponies with chronic biliary T-tube fistulas. Excreted bile was quantitatively recovered. Uptake was calculated from the plasma disappearance of 14C-labeled bilirubin. Biliary bilirubin excretion was determined directly in excreted bile. When bile acid excretion was low (during continuous drainage without bile acid replacment), bilirubin excretion was 37% less than uptake. Uptake and excretion were essentially identical when taurocholic acid was infused to replace bile acids. After depletion of the bile acid pool, replacement of bile acids (by taurocholic acid infusion) greatly increased both bilirubin excretion and its biliary concentration for approximately 1 hour. After this initial increase, bilirubin excretion was maintained at a rate approximately 30% greater than the preinfusion rate. Bile acid excretion was found to be essential for normal, endogenous bilirubin excretion.


Erysipelas arthritis in swine: concentrations of complement and third component of complement in synovia. Concentrations of hemolytic complement and of 3rd component of complement were determined in serums and in synovia of normal and arthritic joints in swine affected with arthritis experimentally produced by the inoculation of Erysipelothrix rhusiopathiae. Mean concentrations of complement in arthritic joints were increased from 24.7 to 37.5 50% hemolytic units of complement per milliliter. Third component of complement, expressed as a percentage of the serum concentration, was increased from a mean of 16.9 (normal joint synovia) to a mean of 27.1 (arthritic joint synovia). Also, fast-migrating conversion products of 3rd component of complement were not detected in synovia from arthritic joints. These results are interpreted as indicating a relatively less important role for immune complexes in the pathogenesis of erysipelothrix arthritis than is described for rheumatoid arthritis in persons.


Evaluation of the immune response of cattle to leptospiral bacterins. Cattle were vaccinated against leptospirosis with 3 bacterin preparations: (a) trivalent (serotypes grippotyphosa, pomona, and hardjo) whole cell bacterin; (b) bivalent pomona and hardjo whole cell bacterin; and (c) pentavalent (canicola, grippotyphosa, icterohaemorrhagiae, pomona, and hardjo) cell wall bacterin. Microscopic agglutinating antibody responses in cattle given the last-named bacterin were higher than those in cattle vaccinated with the 2 whole cell bacterins (trivalent and bivalent). However, microscopic agglutinating antibody responses occurred in all vaccinated cattle after they were given a challenge inoculation of serotype hardjo. Leptospires were isolated from 2 of 4 challenge controls (i.e., not given any bacterin), but none of the 15 vaccinated cattle given any one of the bacterins and then challenge inoculated with hardjo became culturally positive. It was concluded that the 3 multivalent bacterins were protective against experimental challenge inoculation of hardjo.


Experimentally induced infectious bovine keratoconjunctivitis: resistance of vaccinated cattle to homologous and heterologous strains of Moraxella bovis. In studies to determine whether vaccination with one strain of Moraxella bovis would protect against challenge with virulent homologous or heterologous strains, calves were intramuscularly inoculated 3 times with formalin-killed M bovis, with 14 days between inoculations. Fourteen days after the 3rd vaccinal dose was given, all calves were exposed to homologous or heterologous virulent cultures of M bovis. The results indicated that vaccination with one strain of M bovis may induce protective immunity against homologous and heterologous challenge exposure; however, because vaccinated cattle resisted infection and disease produced by a homologous strain to a greater extent than they resisted those produced by heterologous strains, polyvalent vaccines or highly immunogenic common antigens may be needed to protect cattle against the numerous strains they might encounter under natural field conditions. There was minimal correlation between the presence of precipitating antibodies against the heterologous strains and the establishment of infection and disease.


Attempts to produce protection against Ostertagia ostertagi in cattle. Various single or multiple doses of Ostertagia ostertagi were administered to young calves, and the production of protection phenomena elicited by single challenge inoculations ranging from 50,000 to 300,000 larvae or multiple challenge inoculations totaling 98,000 and 300,000 larvae was investigated. With some regimens, the vaccinations apparently resulted in protection against challenge exposure, as reflected by 36 to 56% fewer worms becoming established in challenge-exposed vaccinated calves than in challenge-exposed nonvaccinated, control calves. Other protection phenomena were elicited by some vaccinated calves of significantly more female worms lacking the distinctive vulval flap of O ostertagi and harboring significantly fewer eggs per female. Challenge exposure with a pathogenetic dose of 300,000 larvae produced the same degree of retarded weight gain in vaccinated as in nonvaccinated calves, and at necropsy, visceral lesions and pathologic alterations were equally severe in both groups of calves.


Cecal coccidiosis in poultry as affected by prior exposure to aflatoxin B1. Young New Hampshire and broiler chickens were given feed containing 2 concentrations of aflatoxin B1 (0.2 or 2.0 ppm). The larger concentration caused severe toxicosis and death in the New Hampshire chicks, but did not cause gross signs in the broiler chicks. However, temporary stunting was seen on both New Hampshire and broiler chicks during periods of aflatoxin feeding, along with persisting decreased weight gains in the broiler chicks; the latter apparently recovered during the next 21 days of feeding the starter ration. New Hampshire and broiler chicks which were given feed containing aflatoxin B1 at concentrations of 0.2 and 2.0 ppm for 28 days followed by a 21-day "recovery period" and which were not given a coccidiostat were more susceptible to severe cecal coccidiosis and had more persisting hepatic and cecal lesions than did chicks not given aflatoxin. The coccidiostat was protective against both cecal damage and losses in checks challenge exposed at 49 days of age to 100,000 infective Eimeria tenella oocysts.


Homidium (ethidium) bromide inhibition of avian reovirus replication. Homidium bromide inhibited replication of avian reovirus in cell culture. Inhibition was dose dependent, and the critical event required that the dye be present during the replicative viral cycle and was not attributable to a cellular function.


Coccidiostatic action of monensin fed to lambs: body weight gains and feed conversion efficacy. Thirty crossbred ewe lambs weighing an average of 37.3 kg were allotted to 6 groups of 5 lambs each so that group weights were nearly equal. Lambs were fed dehydrated alfalfa pellets, initially at 1.14 kg/day and subsequently increased after experimental day 15 and 42. Each lamb was artificially infected with 18,000 sporulated oocysts of Eimeria ninakohlyakimovae. Groups 1, 2, 3, and 4 were given monensin in the form of medicated alfalfa pellets at dose levels of 5, 10, 20, and 30 g/metric ton, respectively. Groups 5 and 6 were infected controls (infected, nonmedicated). Lambs in groups 5 and 6 developed severe clinical coccidiosis, having diarrhea and losing weight rapidly. Group 1 lambs did not have diarrhea, but the lambs did not gain well. All other medicated lambs gained weight during the experimental period of 84 days. Feed conversion was good in medicated groups 2, 3, and 4 and was poor in control groups 5 and 6. Statistically significant differences in feed conversion and body weight gains (5 and 1% level of confidence) were observed between control and medicated groups.


Surgical implantation of electroencephalographic electrodes in the dog. A simple surgical technique for implanting chronic electroencephalographic electrodes in the skull of the dog was devised to obtain electroencephalograms from nonsedated and nonanesthetized dogs frequently. Orthopedic screws were used as implant electrodes and for securing the recording assembly over the frontal sinus. The electrode assemblies have been tolerated well for as long as 10 months in 17 of 20 dogs and have given reliable and satisfactory electroencephalograms for computer analysis and have been virtually free of all physiologic and motion artifacts in all dogs, with minimal use of physical restraint.


Immunity to leptospirosis: renal changes in vaccinated cattle given challenge inoculum. Resistance to renal leptospirosis was demonstrated in cattle vaccinated with Leptospira interrogans serotype pomona bacterin. Fewer vaccinated cattle given challenge inoculum of virulent serotype pomona leptospires 12 months after vaccination had kidneys with gross focal lesions in the cortex than did nonvaccinated controls. Histopathologic changes characteristically associated with renal leptospirosis occurred less frequently and renal tissue damage was less severe in vaccinated cattle than in nonvaccinated controls. The isolation of serotype pomona from only 1 of 29 vaccinated cattle, compared to 7 isolations from 11 nonvaccinated cattle, at 26 days after challenge inoculum was given, indicated that mild renal infection occurred only infrequently in vaccinated cattle. It appeared that challenge inoculation of vaccinated cattle with virulent serotype pomona leptospires stimulated an accelerated secondary immune response in which immunity limited the multiplication of leptospires in the kidney.


A porcine cyclops with normal female karyotype. The chromosomes of a porcine cyclops were examined after a culture was made of tissue from one kidney. The 2n number of chromosomes was 38,XX, with no apparent deviations from that of a normal female swine. Possible factors contributing to this abnormality are discussed.


Hematologic values for free-ranging urban gray squirrels (Sciurus c carolinensis). Gray squirrels (Sciurus carolinensis carolinensis) (N=180) from Jacksonville, Fl, were examined for hematologic values: erythrocyte sedimentation rate, packed cell volume, hemoglobin (Hb) concentration, erythrocyte and leukocyte counts, differential leukocyte counts, blood platelet counts, Hb electrophoresis, and erythrocyte fragility. Results were compared by age and by sex of the squirrels and by month of capture.


The elastase activity of alveolar macrophages: measurements using synthetic substrates and elastin. Hamster, rat, guinea pig, and rabbit alveolar macrophage extracts were tested for elastase activity using elastin suspended in agar and two synthetic substrates, p-nitrophenyl N-tert-butyloxycarbonyl L-alaninate (NBA) and succinyl-L-alanyl-L-alanyl-L-alanine-p-nitroanilide (SLAPN). Activity against NBA was easily detectable, but there was no activity against SLAPN or against elastin-agar, although the assay procedures employing these substrates measured as little as 50 and 2 ng of pancreatic elastase, respectively. We concluded that unstimulated alveolar macrophages from these animals do not contain elastase, and that NBA activity is misleading as an indicator of elastolytic activity in crude alveolar macrophage extracts from these species.


Abnormal lung elasticity in juvenile diabetes mellitus. Static lung pressure-volume curves, lung volumes, spirometry, diffusing capacity for CO, and airway and total pulmonary resistance were determined in 11 young men with juvenile-onset diabetes mellitus who were not cigarette smokers. Twelve nonsmoking men of similar age without diabetes served as control subjects. Elastic recoil at low lung volumes was significantly less in the diabetics than in the control group. Total lung capacity was also decreased in the diabetics. There were no significant differences between the 2 groups in the other parameters of pulmonary function measured. It is postulated that the abnormalities in lung elastic behavior are manifestations of the widespread elastin and collagen abnormalities that have been demonstrated in diabetes and are, in some respects, similar to those that occur during normal aging. Loss of elastic recoil at low lung volumes may cause more significant decreases in flows and gas transport as the juvenile diabetics age.


Response of asthmatics to methacholine and suggestion. Effects of diluent, methacholine, and suggestion on pulmonary function were studied in 9 asthmatic subjects. On day 1, flavored diluent was given as a control preparation. On day 2, increasing concentrations of similarly flavored methacholine were administered. On day 3, the effect of flavored diluent plus suggestion was studied. Although all variables were affected, the dose-response relationships for methacholine were most pronounced for specific airway conductance and airway resistance, in contrast to maximal mid-expiratory flow, forced expiratory volume in 1 sec, and forced vital capacity. Suggestion toward bronchoconstriction significantly affected only the plethysmographic parameters, specific airway conductance, and airway resistance, and not the spirometric variables. Both airway resistance and 1-sec forced expiratory volume showed slight, but significant, changes as a result of bronchodilator suggestion, which was used to overcome the suggestion toward bronchoconstriction. Because suggestion had a greater effect on large airways than peripheral airways, a role for the vagus is implied. Thus, any protocol using body plethysmography must consider a possible effect of suggestion on results.


Regional lung function in chronic pulmonary congestion with and without mitral stenosis. Relative regional ventilation and perfusion were measured with xenon-133 in 16 seated patients with pure or predominant mitral stenosis (group 1) and in 12 patients with chronic pulmonary congestion due to left-sided heart disease without mitral stenosis (group 2). The apex-base perfusion gradient was abnormally reduced and often reversed in group 1 patients. There was a significant negative correlation between perfusion gradient and mean pulmonary capillary pressure in both groups, but for a given elevation of pulmonary capillary pressure the perfusion gradient tended to be greater (i.e., less abnormal) in group 2. The regression line of perfusion gradient on pulmonary capillary pressure indicated that perfusion gradient had a value of zero (indicating reversal of the perfusion gradient) at a mean pulmonary capillary pressure of 26 mm Hg in group 2 but at only 18 mm Hg in group 1. Relative lower zone ventilation was abnormally reduced in group 1 and there was a significant negative correlation between ventilation gradient and pulmonary capillary pressure in group 1 but not group 2 patients. Comparison of the distribution of slowly inhaled small volume boluses, large volume boluses, and inspiratory capacity breaths of 133Xe suggested that the lower zone hypoventilation was due mainly to closure of peripheral airways but that selectively increased resistance and reduced compliance in the lower zones may contribute in some patients. Both ventilation and perfusion were reduced at the lung bases in group 1 patients, and between regions nonuniformity of relative ventilation/perfusion was significantly less than normal. Although ventilation distribution was relatively normal in group 2 patients, they also had significantly less regional ventilation/perfusion nonuniformity than normal subjects.


Relapse in pulmonary tuberculosis.

Relapse in pulmonary tuberculosis. Five hundred forty-three patients with bacteriologically confirmed pulmonary tuberculosis who successfully completed treatment were followed for 5 years to determine relapse rates and to see whether any factors could be said to predispose to relapse. Practically the entire treatment of these patients had been carried out in their homes. The cumulative relapse rate during a 5-year period was 11.60 per cent. Relapse rates were low during the first 2 years of follow-up. Of the various factors considered in the analysis, age, sex, initial extent of disease or cavitation, and presence of initial or emergent drug-resistant bacilli did not influence the relapse rate. Patients who achieved complete radiographic clearing at the time treatment was stopped and those who were regular in treatment had comparatively low relapse rates. Cured patients included in the study were asked to report at least once annually for a checkup, and immediately if they developed any symptoms suggestive of relapse. Only one fourth of the cases of relapse were detected during routine annual checkup; in the remaining cases, the patients attended ahead of the next due visit because of symptoms. This casts doubt on the utility of keeping cured patients under prolonged routine surveillance.


Prognosis after recovery from adult respiratory distress syndrome. Ten patients who survived an acute episode of the adult respiratory distress syndrome were studied on recovery. Serial pulmonary function tests performed in 3 subjects revealed a tendency toward normalization of values at 4 to 6 months after the episode, with a subsequent serial decrease in maximal mid-expiratory flow rates, and a partial reversal by bronchodilators. Of the 10 patients, 6 had dyspnea on exertion and all but one of the 6 were smokers. The ventilatory tests revealed a predominantly restrictive pattern in 2 patients and an obstructive pattern in 4. The 4 asymptomatic patients had essentially normal pulmonary function. Pathologic features of the lung, available in 3 cases, are discussed.