Parapleurogonius brevicecum gen. et sp. n. (Trematoda: Pronocephalidae) from a freshwater turtle in peninsular Malaysia. Parapleurogonius brevicecum gen. et sp. n. is described from the freshwater turtle, Kachuga trivittata, in Selangor, Malaysia. Parapleurogonius is most closely related to Pleurogonius Looss, 1901, but from which it can be distinguished by the termination of the ceca at or just overlapping the anterior border of the testes and the pretesticular position of the excretory pore. Additionally, Parapleurogonius is described from a freshwater turtle, whereas Pleurogonius is only known from marine hosts.


Angiostrongylus malaysiensis in Indonesia.


Biology of the snail-killing fly, Sepedon spangleri Beaver (Diptera: Sciomyzidae). II. Ability of the larvae to kill snails of medical importance in Thailand. S. spangleri larvae preferred five species of non-operculate snails; Gyraulus convexiusculus Hutton, Segmentina hemisphaerula Benson, Hippeutis umbilicalis Benson, Indoplanorbis exustus Larambergue, and Trochobis trochoideus Benson. They occasionally consumed the operculate snails: Melanoides tuberculata Muller, Lithoglyphopsis aperta, Hubendickia siamensis Brandt, Lacunopis munensis Brandt, Tarebia granifera, Lamarch and Viviparus sp. but were innocuous to Bithynia laevis Lea.


Observation on biting midge infestations on Mamburao Beach, Mimdoro, Philippines. The occurrence of biting midge infestation involving the species Leptoconops (Styloconops) spinosifrons Carter 1921 (Diptera, Ceratopogonidae) is reported from a beach resort in Mindoro Island, Philippines. The flies are most active between 0700 and 0900 hours, and again, between 1600 and 1800 hours; they are most abundant in the shoreline and sand beach area.


A case of human infection with Newcastle disease virus. A case of Newcastle disease virus infection in a female laboratory technician is reported for the first time in Malaysia. Infection was acquired by droplet infection of the eye while grinding infected chicken in the laboratory. The case was confirmed by isolation of Newcastle disease virus from an eye swab taken from the subject on the first day of clinical signs. A four-fold rise of haemagglutination-inhibition titre was shown when sera on the third day of infection and 15 days later were compared.


SEAMEO-TROPMED Scientific Group Meeting: Malaria in Southeast Asia.


Relevance of medical research to patient care.


H.R. 1: model for an effective NHI program.


The proposals are many and varied...but some tough questions remain.


A sampling of public opinion.

A sampling of public opinion.


Quality assurance: whose responsibility?


Short-term results of combined radioimmunotherapy in inoperable lung cancer. Fifty-three inoperable lung cancer patients were treated with radiotherapy combined with immunostimulation with BCG. A good response was obtained in 30 patients (56%); the results were not significantly different than those obtained with a control group of 50 lung cancer patients matched by age, sex and stage of the disease (24 out of 50 equals 46%). These short-term results were compared with the immunologic "status" of patients evaluated before treatment by the parameters monitoring in vivo and in vitro delayed type hypersensitivity. The good response to therapy was documented in a higher percentage of patients with positive skin tests to recall and standard antigens and with normal values of lymphocyte transformation with PHA and Rosette E-forming cells, in comparison with patients with low levels of immunocompetence. An impairment of the cell-mediated immune response was found after combined therapy, presumably due to radiotherapy. BCG was not able to restore the patient's immunocompetence, no effect on host's immune reactivity was demonstrated. As regards humoral immunity, the patients with low levels of IgG before treatment (12/14) showed a good response.


Activity and intracellular localization of lysosomal acid phosphatase in lymphocytes from patients with Hodgkin's disease, plasma cell myeloma and primary polycythemia. Using the cytochemical method after Barka and Anderson, activity and localization of lysosomal acid phosphatase (AP) was determined in peripheral-blood lymphocytes from 20 healthy subjects, 10 patients with Hodgkin's disease (HD), 10 patients with plasma cell myeloma (PCM), and 10 patients with primary polycythemia (PP). Total count of AP-positive lymphocytes was lowest in the patients with HD. Moreover, they showed a significant decrease of the absolute count of lymphocytes with well formed and more numerous AP-positive lysosomal granules. Analogous alterations in lymphocytes from patients with PCM and those with PP were much less significant. The authors discuss the importance of the above-mentioned observations for evaluation on a cellular basis of lowered immunity of patients with lympho-proliferative and myelo-proliferative disorders, with special regard to AP as a T-cell marker.


N-acetyl-beta-glucosaminidase of peripheral blood lymphocytes in patients with cancer of the larynx. In 20 men, age 35 to 55 years, with cancer of the larynx of N-acetyl-beta-glucosaminidase in peripheral blood lymphocytes was determined cytochemically according to Hayashi's method. Numbers of enzyme-positive cells were counted with regard to the type of cytochemical reaction (granular, granular-diffuse, or diffuse), and to the number of enzyme-positive lysosomal granules within a single cell. In comparison to 20 healthy men, age 20 to 30 years, the following changes were noted in the patients: 1) the decrease of the total count of enzyme-negative lymphocytes; 2) the decrease of the total count of lymphocytes with granular type of reaction; 3) the increase of the counts of lymphocytes with granular-diffuse and diffuse type of reaction. The authors suggest that these changes could be related to the immune reaction of specific tumor antigens.


The sacco-cerebellar tract of "Scylliorhynus canicula" L. Preliminary report.


X/X translocation in a girl with gonadal dysgenesis.


ABO grouping of blood stains by rapid mixed agglutination without first washing.


The incidences of thyroid autoimmunity in diabetics and in patients with insulin autoimmunity.


Clinical studies on 56 cases of oral malignant tumor.


An autopsy case of myocardial sarcoidosis.


Electron microscopic studies on retinal capillaries in human diabetic retinopathy.


Evidence for soluble estradiol receptors in the amygdala of male and female rats.


The Dalkon Shield litigation.

The Dalkon Shield litigation.


A perspective on health care and women in the Mississippi delta.


An autopsy case of mucinous cystadenocarcinoma of the liver.


Complement fixation to pleuropneumonia-like organism and cold hemagglutination titers in children with primary atypical pneumonia.


A scanning electron microscopic study on implantation of Ehrlich ascites tumor cells in the peritoneal layer.


Studies on RNA turnover in rat tissues.

Studies on RNA turnover in rat tissues.


Comparative observation on surface topography of teguments and eggshells of diphyllobothriid cestodes by scanning electron microscopy.


Thermal sensibility of the receptor in the knee joint.


Experiences of a pelvic teaching group.

Experiences of a pelvic teaching group.


Clinical and serological observations of streptococcal infection.


The effects of electrical acupuncture on human somatosensory evoked potentials and spontaneous brain waves.


Woman workers and job health hazards.

Woman workers and job health hazards.


Focus: Women's Health-Federal Commitment.


Commentary: continuing the discussion of women and national health insurance.


The national center for health education in the US: a role of major significance.


An exciting prospect.

An exciting prospect.


Birth of the first centre for professional preparation in health education in Africa.


Formation of root hairs by the wheat Triticum Vulgare Host. Trichoblasts. The process of root hair formation has been studied by light-, transmission-and scanning electron microscopy. In the course of root hair development a break of the outer cell wall is observed by electron microscopy. It apparently occurs after the break of the fibrillar layer. The break of the outer layer of the cell wall is assumed to represent the break of the outer mucilage, the cuticle and the adjoining amorphous matrix with irregularly oriented cellulose microfibrils. The scheme of successive ultrastructural changes in the outer cell wall pattern during root hair formation is presented.


Carbohydrates from hydrocarbons. II. Free and bound sugars from yeast cells grown on n-hexadecane. Candida lipolytica (strain 10) was grown on an n-hexadecane medium with and without yeast extract. The harvested dry cells were weighed at various stages of growth. The free sugars from the cultures were obtained by Soxhlet extraction with 85% ethyl alcohol. Further qualitative and quantitative analyses of free monosaccharides in the concentrated alcoholic extracts were made by paper chromatography. Glucose was the only free monosaccharide that could be identified at various stages of growth. The chromatographic analysis of the acid-hydrolyzed yeast cells indicated the presence of glucose and mannose as dominant bound sugars; galactose and xylose were present in minor quantities. In the harvested dry cells from the yeast extract-containing medium, in general, greater amounts of bound sugars were present.


Spinal bupivacain anaesthesia in traumatological surgery. Two-hundred forty spinal cases of bupivacain anaesthesia are reported. One third of the patients was over 60 years of age and one quarter in a poor condition. No serious or lasting complications were observed. In the overwhelming majority anaesthesia during operation was satisfactory, thus the drug was found suitable for use in traumatological surgery. Due to its protracted effect, bupivacain ensures analgesia in the early postoperative period.


The Soichet intrauterine device in the treatment of intrauterine adhesions. IUD in the shape of a "Y" was inserted following curettage to 32 patients suffering from missed abortion or post-partum hemorrhage for the prevention of intrauterine adhesion formation, and to 48 patients suffering from sterility as a result of intrauterine adhesions. The rate of adhesion formation or recurrence of adhesions after their removal by curettage was very low and dropped significantly compared to other IUD's.


True pubertas praecox in a girl; onset at nineteen months. The authors report a case of true pubertas praecox in a girl with onset at 19 months; they describe the principal histopathologic, clinical and laboratory features and discuss problems of etiopathogenesis and differential diagnosis, as well as the prognosis and treatment of this disorder.


Kinetic and electrophoretic studies on the cyanide insensitive NADH diaphorase of human polymorphonuclear leukocytes.


Incomplete type I male pseudohermaphroditism. The observation of a case of male pseudohermaphroiditism offered the opportunity for an analytical review of this pathology. Clinical features and failure to respond to prolonged testosterone treatment allowed this case to be included in the group characterized by androgen resistance of which a recent classification distinguishes various types on the basis of phenotypic and hormonal features. Incomplete virilization of the external genitals and high testosterone and LH plasma levels were evidence in favour of the conclusion that the case should be classified as incomplete male type I pseudohermaphroditism.


First oviduct transplants.

First oviduct transplants. The first four cases of oviduct transplantation are described. In the first case, it consisted in the substitution of an oviduct that could not be recanalized after previous sterilization; two further patients had undergone salpingectomy for ectopic pregnancy, and one had been salpingectiomized for salpingitis. Donor oviducts preserved in liquid nitrogen at--196 degrees C were used as grafts. Rejection was prevented by countersensitization according to Theurer, also a first instance of the use of this method to be recorded in the literature.


The significance of the combined dexamethasone-HCG test for the assessment of hyperandrogenism. The combined dexamethasone-HCG test was employed in 57 patients with excessive androgen secretion in order to differentiate the Stein-Leventhal syndrome from other disorders associated with increased androgen production. The patients were classified according to the test results. All except two of the patients gave a test result typical for the Stein-Leventhal syndrome.


Preparation for surgery in cases of sterility. The author illustrates various techniques to be applied in preparation for diagnostic and therapeutic procedures for sterility, such as perflation, hysterosalpingography, endometrial biopsy, culdoscopy and laparotomy.


The effect of denervation on carnitine metabolism in rat skeletal muscle. We investigated the effect of denervation upon the concentration of carnitine, the activity of carnitine palmityltransferase and carnitine acetyltransferase in the "red" soleus and "white" extensor digitorum longus muscles of the rat. Soon after denervation a marked drop in the amount of muscle carnitine was observed, that was more pronounced in the "red" soleus. The activity of both CPT and CAT decreased in both types of muscle, but CPT activity decreased to a greater extent in the soleus than in the EDL. These data may be indicative of a more impaired fat combustion in the "red" than in the "white" muscle following denervation.


Specificity of trypsin and alpha-chymotrypsin towards neutral substrates. Steady state kinetics of the hydrolysis by trypsin and chymotrypsin of the ethyl esters of the N-acetyl derivatives of glycine, L-alanine, DL-2-aminobutyric acid, L-norvaline, L-valine, L-norleucine and L-leucine were studied at pH 6.6 and 25 degrees C. It is apparent from the second-order rate constants, kcat/Km, app, that there is a significant difference between the specificities of the two enzymes toward substrates with a long side chain, such as the derivatives of norvaline, norleucine and leucine. The carboxylate ion Asp-189 in the specificity pocket of trypsin seems to interfere with the productive binding of substrates containing apolar side chains longer than those of the derivatives of DL-2-aminobutyric acid or L-valine. The basic group of the specific substrates of trypsin, such as that of lysine and arginine derivatives, promotes the binding of the apolar side chain by neutralizing the negative carboxylate ion of Asp-189.


Biological fundamentals of consciousness.


Enkephalin analogs with enhanced opiate activity.


Light and electron microscopic study of an intermediate sertoli-leydig cell tumor with a review of literatures in Japan.


LH determination in unconcertrated urine by a haemagglutination test. A hemagglutination test for luteinizing hormone (LH) in unconcentrated urine is described, in which erthyrocytes are sensitized with anti-human chorionic gonadotropin (HCG) rabbit gamma globulin and the presence of HCG or LH indicated in samples without ring formation.  24 urines were collected from 8 ovulating women throughout the menstrual cycle.  The urine test has a sensitivity for LH of 12.5 IU/liter.  The test takes 2 hours.  Effects of the presence of follicle stimulating hormone (FSH), salt, glucose, human serum albumin (HSA), and human gamma globulin (HGG) on the estimates were determined.  The test was unaffected by the presence of glucose and salt up to 1.0 and 10 gm/dl, respectively.  HSA (50 mg/dl) and HCG (500 mg/dl) had some effects on ring pattern.  FSH had little effect on LH estimation.  The urine test was then compared with LH levels in serum as determined by radioimmunoassay.  Changes in LH secretion by the urine tests paralleled LH changes in the cycle as determined by serum LH radioimmunoassay.


Experimental induction of chorionepithelioma in pregnant rats.


Early detection of pregnancy around the first missed menstrual period by 2 hour haemagglutination test. A very early hemagglutination test which has the sensitivity of 5-6 IU eq of human chorionic gonadotropin (HCG) per liter is discussed.  It requires only 2 hours.  Concomitant follicle stimulating hormone has little effect on the estimated HCG.  Urine from 56 women was used with only simple filtration.  19 of these women became pregnant during the study period.  HCG/luteinizing hormone was quantitatively analyzed with Higonavis.  The excretion of HCG in the urine began to increase from the 12th day of the high temperature phase in pregnant women and then increased very rapidly.  Therefore, pregnancy can be assumed by the rapid increase before the 1st menstrual period.  At this time an increased risk of early abortion can be treated, or an unnecessary menstrual regulation procedure can be avoided by use of this test.  Performance of abortion is safer when done early.


Studies on histogenesis of experimentally induced chorioepithelioma in rats.


Effects of progesterone on the growth kinetics and the morphology of a human endometrial cancer cell-line.


Adjuvant hormone therapy to radiation treatment for cervical cancer.


Statistical analysis of birth-weight and postnatal growth.


Reinvestigation of crucial cases where first diagnosis by mailing smear test disagrees with second diagnosis by cytology and/or biopsy.


Induction of SFD by microspheres blocking of placenta in rats and its influence on utero-placental blood flow.


Observation of rapid migration of trophoblastic cells from human chorionic villi cultured on fixed gelatin film.


Influence of androgen on endometrial monoamine oxidase activity of rats.


Single umbilical artery --a review of 37 cases--.


A study on contraceptive use. Effectiveness of the 75 mcg. ethinyl estradiol sequential therapy. The contraceptive effectiveness of a sequential oral contraceptive (OC) regimen was evaluated in 160 women over a total of 2031 cycles.  The regimen consisted of 75 mcg/day ethinyl estradiol (EE) for 15 days, followed by 75 mcg/day EE plus 1.7 mg/day chlormadinone acetate for 5 days.  Treatment was initiated on the 5th day of each menstrual cycle.  3 pregnancies occurred during the course of the study.  1 of these was attributable to failure to follow the treatment schedule correctly.  Only 1 pregnancy was directly attributable to product failure.  The overall pregnancy rate was 1.8, which is comparable to that for the regimen involving 100 mcg/day EE.


Observations of guinea pig syncytiotrophoblast cultured in vitro.


An ultrastructural study of collagen degradation in human involuting uterus.


Studies of Toxoplasma antibody IGG and 19S IGM by the method of sephadex plate gel filtration.


A kinetic study of carbohydrate metabolism in pregnancy. A glucose turn over following one shot intravenous injection.


A case of gonadoblastoma.

A case of gonadoblastoma.


Accelerating method for prepared condition of delivery.


Studies on the formation of experimental small for date (SFD) induced with actinomycin D in pregnant rat.


Studies on the placental functions of experimental SFD in rats.


Utero-placental blood flow in several abnormal pregnancies of rats studied with the microspheres method.


Steroid hormone formation in vitro by human ovarian follicles with different structures.


Effect of the interferon inducer tilorone in inbred CBA mice. Tilorone hydrochloride (200 mg/kg) was administered intragastrically to inbred CBA mice. After 5, 18 and 48 hr the number of circulating leucocytes and peritoneal cells as well as the migration of unstimulated peritoneal cells, the blood corticosteroid level and interferon production were investigated. In spite of the considerable decrease of the number of mononuclear cells in the blood and polynuclear ones in the peritoneal exudate, the drug induced production of circulating interferon and stimulated its synthesis by peritoneal cells. The blood corticosteroid level and the mast cell count in the peritoneal cavity were significantly elevated, but the migration of peritoneal cells in antigen-free medium decreased.


Taxonomy of primycin producing actinomycetes. I. Description of the type strain of thermomonospora galeriensis. Strain FBUA 1274 (=strain 28/650707, Hungarian National Collection of Medical Bacteria, National Institute of Public Health, Budapest) is designated the type strain of Thermonospora galeriensis (Vályi-Nagy et al.) comb. nov., and the morphological characteristics of this strain are described.


Drugs in the dynamic model on schizophrenia. A literature review.


A multidimensional model of schizophrenia.


Practicum-internship. I: Development, implementation and student participation.


Hospital cost inflation and physician payment.


Practicum-internship. II: Interim evaluations.


Pharmacy internship in Minnesota: outgrowth of an extensive evaluation program.


The incorporation of basic life-support training in the pharmacy curriculum.


Improving the quality of the pharmacist as a drug advisor to patients and physicians through continuing education.


A self-instructional law course--teaching by learning objectives.


Pharmacy education in an Area Health Education System.


The interface of public administration and pharmacy administration.


Monitoring patient drug profiles and the legal liability of the pharmacist.


Issue identification approach to pharmacy education planning. I: overview of some major issues.


Square drawing test. Anew quantitative ataxia test.


Some results of the application of the stabilograph in the orthopaedic clinic. A preliminary report.


Electrogravitiograph of crippled children.


Stabilography as a diagnostic tool in child neurology.


Equilibrial approach to scoliotic posture.


System of human equilibrium control.

System of human equilibrium control.


Action of liver on the in vitro brain cortex resporatory process. A neurometabolic hepatic factor.


Further investigations on the function of juxtamedullary nephrons in conscious rats.


Physician-pharmacist and medical malpractice.


Pharmacist-patient communication: its effect on pharmacy's image.


Glucose-6-phosphate dehydrogenase of Biomphalaria glabrata (Say , 1818) (Mollusca: Pulmonata). Characterization and inheritance pattern. Glucose-6-phosphate dehydrogenase of Biomphalaria glabrata has been characterized by electrophoresis, kinetic properties and inheritance pattern. It exists as a single electrophoretic band with no polymorphism in the natural population studied during the present investigations. There are no organ-specific differences in electrophoretic pattern. The enzyme from the homogenates of various organs e.g., albumen gland, digestive gland, ovotestis and columellar muscle show similar physico-chemical parameters, such as optima for pH, NADP and glucose-6-phosphate. Incorporation of NADP is essential for maintaining the stability of the enzyme, failing which, there appear artifactual variations in electrophoretic mobility of the enzyme. The apparent lack of polymorphism in natural population of Biomphalaria glabrata has been discussed.


Hygiene standard for impulse noise from the Committee on Hygiene Standards of the British Occupational Hygiene Society.


Calculated in-ear A-weighted sound levels resulting from two methods of hearing protector selection.


Characterization of respirator adsorbent filters by means of penetration curve parameters.


An international comparison of counts of airborne asbestos fibres sampled on membrane filters.


Evaluation of natural wet bulb and wet globe thermometers.


Particle size distribution and human respiratory deposition of trace metals in indoor work environments.


An investigation of lead workers for subclinical effects of lead using three performance tests.


A comparison of reactions to industrial protective clothing.


Toxicity of combustion products with particular reference to polyurethane.


Short-term exposure limits.

Short-term exposure limits.


Monitoring local exhaust ventilation systems.


Preventing emissions from manufacturing processes by suitable process design.


Controlling vapours from open surface vessels.


Organizing the engineering control of toxic substances in air.


Cleaning exhaust ventilation air.

Cleaning exhaust ventilation air.


Modern concepts of respiratory protection.


The measurement of shift average exposures to oxides of nitrogen.


Effect of head band forces and pressure on comfort of ear muffs.


The performance of nebuliser and air ejector made from sections of hypodermic needles.


Personal protection--the last resort?

Personal protection--the last resort?


Influence of embryonic and adult testis on the differentiation of embryonic ovary in the mouse. The development of 11 1/2-13 1/2-day embryonic mouse ovaries subjected to the influence of adult and embryonic testes was investigated. The environment of adult testis caused severe restriction of ovarian growth, but did not produce any effects which might be considered as masculinization. The presence of embryonic testis was distinctly unfavourable to the embryonic ovary, resulting in restriction of the growth of the latter and degeneration of oocytes. Reversal of the course of differentiation of genetically female germ cells has never been observed.


The replacement of serum by hormones in cell culture media. The replacement of serum by hormones in cell culture media. (Reemplazo del suero por hormonas en el medio de cultivo de células). Arch. Biol. Med. Exper. 10: 120-121, 1976. The serum used in cell culture media can be replaced by a mixture of hormones and some accesory blood factors. The pituitary cell line GH3 can be grown in a medium in which serum is replaced by triiodothyronine, transferrin, parathormone, tyrotrophin releasing hormone and somatomedins. Hela and BHK cell strains can also be grown in serum free medium supplemented with hormones. Each cell type appears to have different hormonal requirements yet it may found that some hormones are required for most cell types.


Intercountry coordination in the development of manpower.


Cell membrane and cell junctions in differentiation of preimplanted mouse embryos. Cell membrane and cell junctions in differentiation of preimplanted mouse embryos, (membrana celular y uniones celulares en la diferenciación del embrión de ratón antes de la implantación). Arch. Biol. Med. Exper. 10: 130-134, 1976. The development of cell junctions that seal the peripheral blastomeres could be a decisive step in the differentiation of morulae into blastocysts. The appearance of these junctions is studied by electron microscopy of late morulae and initial blastocysts. Zonulae occludentes as well as impermeability to lanthanum emulsion precedes the appearance of the blastocel and hence might be considered as one of its necessary causes.


Hormone action on the cell nucleus: effect of erythropoietin and testosterone on bone marrow. Experiments intended to correlate the biochemical action of erythropoietin and testosterone on marrow cells are presented. Both hormones seem to act at different cytological and biochemical levels. Erythropoietin triggers the erythropoietic phenomenon acting on the Erythropoietin-Sensitive Cells. Inducing the synthesis of a large size RNA, (85S) which after a ribonuclease-dependent processing mechanism generates the informational RNA (9S) required for hemoglobin synthesis. Testosterone acts directly on bone marrow (probably at the level of polychromatophylic erythroblasts) enhancing the synthesis of ribosomal RNA or its precursors and stimulates a nuclear ribonuclease which might represent a control mechanism on the processing of high molecular weight RNAs. It is postulated that erythropoietin and testosterone act synergistically to create the biochemical machinery for hemoglobin synthesis.


Appearance of morphologically aberrant cells of Micrococcus lysodeikticus (luteus) in medium with papain.


The psychological and social effect of design.


Complexity and order of the human circadian system.


Intracellular potentials of cortical neurons and surface activity: I) During epileptogenic discharges induced by pentylenetetrazole in rats.


Intracellular potentials of cortical neurons and surface activity: II) During epileptogenic discharges induced by strychnine in the rat.


Salt discriminating properties in single tarsal hairs of Phormia regina M.


USA--women health workers.

USA--women health workers.


The audio cassette library: a new credibility gap?


The medical curriculum: making a production of it.


Medical instant photography: tips on picture quality.


Medical instant photography: photomicrography & Polacolor 2.


Medical instant photography: the diagnostic picture.


Medical instant photography: instant aid for a busy biophotographer.


The free loan philosophy: the rationale behind Pharmaceutical program operations.


Third annual directory of pharmaceutical programs.


Physicians Radio Network: an alternative to eyestrain.


MIST - what is it?

MIST - what is it?


Health maintenance organizations: an overview. Part I.


Executive vice president's rounds: Governance by consensus.


Multi-Media ACP self-learning series set for distribution to subscribers.


Board of regents statement: recertification and relicensure.


Health Maintenance Organizations: part II. Some frequently asked questions.


Executive vice president's rounds: internal medicine and primary care.


Recertification: has it touched your life?


Executive vice president's rounds: the College and continuing medical education in South America.


Oral examinations: pro and con.

Oral examinations: pro and con.


State legislation: its growing regulative domain.


ACP Major Hospital Expense Insurance.

ACP Major Hospital Expense Insurance.


Dominance in the visual system.

Dominance in the visual system.


Lassa fever (arenaviruses) as a public health problem. Two "new" virus infections, Marburg and Lassa fever, now constitute diseases of public health importance in several countries of Africa, especially West Africa. Lassa fever has an insidious onset, is initially difficult to diagnose, has "nonspecific" clinical symptoms which have been confused with yellow fever and typhoid, shows evidence of persistent infection, is tremendously contagious, has a high mortality rate, and in particular exhibits unusual nosocomial propensity. It has also been shown to be the cause of premature births and spontaneous abortions in pregnant women. The virus is transmitted by the respiratory route and by direct contact with contaminated materials. Persistent complement-fixing antibodies have been demonstrated in patients recovered from the disease. The causative agent, a member of the arenavirus group, is known to be enzootic in rodents, especially Mastomys natalensis.


A method of elicting pattern specific responses and other electro-physiological signals in human subjects.


Refractive development in strabismic children.


Possible effects of changes in lens pigmentation on the colour balance of an artist's work.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on population age-dependent responses to therapy--in vitro.


Dominance in ocular movements.

Dominance in ocular movements.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on population age-dependent responses to therapy--in vivo.


Computer simulation of leukemia therapy: combined pharmacokinetics, intracellular enzyme kinetics, and cell kinetics of the treatment of L1210 leukemia by cytosine arabinoside. An integrated mathematic computer-based model of the pharmacokinetics, intracellular enzyme kinetics, and cell kinetics of the treatment of L1210 leukemia by cytosine arabinoside (ara-C) is described. The compartment model of Bischoff and Dedrick is extended to the intracellular level by inclusion of equations describing the phosphorylation, dephosphorylation, and deamination of ara-C with enzymatic feedback control. The activities of kinase, deaminase, and phosphatase are explicitly included in the models and are estimated from relevant data. Cell proliferation is described by a continuous-flow mathematic model in which cellular maturation and cell-to-cell variability in maturation rates are key variables. Cell proliferation is related to intracellular biochemistry through mathematic expressions which relate cell lethality and progression delay to the time course of intracellular ara-CTP. In vitro and in vivo experiments performed in a number of laboratories are compared by simulation. The most sensitive parameters in dose-response and cell-survival simulations are deoxycytidine kinase activity, ara-CTP half-life, renal clearance of ara-C, and cell-kinetic parameters for proliferation and cell killing. Progression delay is vital to the realistic simulation of divided-dose schedules. By comparative simulation we have identified areas of uncertainty which can be classified by a few additional measurements. The applications of simulations combining pharmacokinetic, biochemical, and cell-kinetic data in vitro and in vivo are discussed, exploring consistency among different measurements, and relating experimental protocols to clinical treatment.


Age-dependent survival and cell-cycle progression of cultured cells exposed to chemotherapeutic drugs.


Effects of surgery on the cell kinetics of residual tumor. Noncurative excision of a primary sc Lewis lung tumor performed on Day 7 or later results in an increase in the thymidine index and growth rate with minimal changes in the cell cycle parameters of the lung metastases. The stimulation of the lung nodules is accompanied by a small but consistent decrease in median lifespan. Sham surgery performed on Day 3 or later also results in a decrease in median lifespan and an increase in the thymidine index of the undisturbed primary tumor. Artifical metastases (10(6) cells iv) are inhibited by the presence of a second (sc) implant and the median lifespan of the doubly implanted mice exceeds that of mice bearing iv implants only. In mice bearing widely metastasized Lewis lung carcinoma, surgery alone may have a detrimental effect on life expectancy, but the residual tumor foci, stimulated to more rapid growth, should be appropriate targets for adjuvant chemotherapy.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on drug lethality and sublethal damage: cytotoxic damage and repair.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on recruitment and synchrony--in vitro.


In vitro responses of mammalian cells to drug-induced potentially lethal and sublethal damage.


Effects of tumor bearing on the dynamics of host hemopoietic cells. Hemopoietic status of the host is an important consideration in any cancer chemotherapy protocol. This paper examines several aspects of the response of the host lymphomyeloid system to tumors transplanted elsewhere: (a) characteristics of host leukocytes migrating into the tumor; (b) leukocyte dynamics in the marrow and the spleen; and (c) dynamics of hemopoietic stem cells. Repeated prelabeling of mice with 3HTdR prior to Ehrlich ascites tumor (EAT) transplantation indicated a large-scale, selective migration and/or retention of newly formed lymphocytes and monocytes within the tumor. Similar observations were also made in sc transplants of strain-specific TA-3(St) tumor. Bone marrow was found to be a major source of these mononuclear cells since their accumulation was suppressed by a prior irradiation of host marrow. Labeling with 125I-antimouse IgM, with or without prior incubation of cells with anti-theta serum, revealed that, within the 7-day-old EAT, about a third of the small lymphocytes were maturing B cells having readily detectable surface IgM, about a third were T cells expressing theta antigen, and the rest had neither marker, possible including very immature B cells. A high incidence of last cell category was also found in subcutaneous TA-3(St) tumors. Ip transplantation of 10(6) EAT cells into CBA/HT6 or TA-3(St) cells into A/J mice caused a transient decline in femoral marrow leukocyte level (affecting lymphocytes most) followed by a recovery and an overshoot. In contrast, there was a steady rise in splenic weight or cellularity mostly accountable for by lymphocytes. This was partly due to local lymphoid proliferation and partly due to extraneous migration. Parabiosis of CBA with T6 chromosome-bearing CBA/HT6 mice revealed that a large proportion of cells dividing in the spleen of the CBA host after tumor transplantation had migrated recently from blood. Using partial marrow chimeras (repopulated with T6 chromosome-bearing marrow cells), bone marrow was identified as their major source. Furthermore, host spleens showed an increased incidence of small lymphocytes bearing no detectable surface-IgM nor theta antigen (possibly inclusive of immature B cells), and a low incidence of T cells. Tumor transplantation produced a rapid and substantial decline in the pleuripotent stem cell (CFU-S) content of the femoral marrow followed by a recovery. The converse was true for the CFU content of the spleen, and in addition, there was an initial rise in the blood CFU level, suggesting an early CFU traffic from marrow to spleen. A qualitatively similar pattern was also noted for stem cells committed to granulocyte or macrophage development as evaluated from in vitro colony assays. An early rise in splenic CFU level was also elicited by injecting sonicated tumor cells or their plasma membrane fractions, thus possibly indicating an antigen-driven effect. A high level of colony-stimulating activity (for in vitro colony growth) was found in the tumor fluid...


Evidence for recruitment and synchronization in leukemia and solid tumors. In malignant cell populations which are sensitive to drug therapy it does not seem necessary to potentiate treatment with perturbation of the proliferative characteristics. However, in some relatively drug-resistant populations significant advantages can be obtained by recruiting resting cells into the drug-sensitive cell cycle. Further studies of growth-regulatory mechanisms for malignant cell populations may help a great deal in designing better methods of recruiting the resting cells back into active cell division. Synchronization of the dividing cells in a specificially drug-sensitive phase of the cell cycle is another method of potentiating chemotherapeutic effectiveness in relatively drug-resistant cell populations. The biochemical changes induced by sequential drug administration may be equally important in sensitizing the malignant cell to subsequent drug administration.


Synchronization with phase-specific agents in leukemia and correlation with clinical response to chemotherapy. Mitotic indices, labeling indices (LI), and tritiated thymidine incorporation into DNA of marrow cells were conducted in patients with leukemia to determine if correlations existed between kinetic measurements, clinical features, and response to chemotherapy. Higher proliferative activity was observed in chronic granulocytic leukemia (CGL) and blastic phase of CGL than in acute leukemia. In acute myelogenous leukemia there was no correlation with various clinical features studied. Those patients demonstrating greater than 60% reduction in circulating leukemia cells within 7 days had a higher initial LI than those with less than 60% reduction. Cytosine arabinoside, methotrexate, and hydroxyurea were investigated to determine their synchronizing capability; cytosine arabinoside and methotrexate were superior to hydroxyurea. In a cycle-sensitive schedule specifically designed to synchronize cells, responses occurred more frequently in patients who increased thier LI 48 hours after priming doses of cytosine arabinoside. In an intensive-chemotherapy schedule which produced more remissions than the cycle-sensitive schedule, there was no relationship between initial kinetic measurements and response. Kinetic values increased as patients achieved remissions.


Size dependence of the response of Lewis lung tumors to BCNU. The survival of Lewis lung tumor cells has been studied after a single ip dose of BCNU. In dissectible subcutaneous and intramuscular tumors and artificial lung metastases survival was measured by colony formation in soft agar and in vivo in the lung. The long-term control of small lung nodules by single doses of BCNU was studied and cell-survival estimates were inferred. The results demonstrate that the cytotoxic action of BCNU shows a strong dependence upon tumor size.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on status of human tumor cell kinetics.


Resting cells in L1210 and JB-1 ascites tumors with special emphasis on recycling.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on drug scheduling--experimental studies.


Role of radioautographic studies in clinical investigative oncology and chemotherapy. Three clinical areas are identified in which radioautographic studies may be of practical usefulness. First, human tumors can be classified according to the predominant pattern of DNA synthesis in the slowly proliferating cell fraction. This classification scheme groups carcinoma of the breast and ovary together, melanoma and carcinoma of the lung together, and places acute adult leukemia in a separate class. If there are correlations between kinetic characteristics and drug response behavior, this classification scheme may simplify the clinical study of new drugs and drug combinations. Second, changes in the labeling index (LI) and/or cell labeling intensity may serve as useful guides in drug scheduling. There are circumstances where changes in cell labeling intensity may be more reliable than changes in the LI. Third, cell morphology, population kinetics, and clinical course may all be correlated in certain human tumors, particularly the lymphomas. Supporting evidence in Sézary's syndrome is presented.


Comparison of cell proliferation kinetics in human and experimental tumors: response to irradiation. Available data on the parameters of cell kinetics in human solid tumors were reviewed. The mean duration of the cell cycle is 2 days; for G1 it is 1 day, for S it is 18 hours, and for G2 it is 6 hours. G1 has the greatest variability from tumor to tumor. The cell cycle and its phases are shorter in animal tumors but the relative durations and variabilities are similar. The labeling index (LI) and the growth fraction vary widely among human tumors, but they are correlated with the histologic type of the tumor. There is a correlation between the mean doubling time and the mean LI of the various histologic types of tumors. Cell loss is considerable in all human tumors, but it is more important in tumors with a high LI. Metastases and recurrence appear to have shorter doubling and cell cycle times than the primary tumor. There seems to be in patients with metastases a correlation between the survival and the growth rate of the metastases. There does not seem to be any correlation between the LI and the probability of dissemination. The depression of LI after irradiation is more important in human tumors than in experimental tumors and varies widely among human tumors. After irradiation, the depopulation seems more important in tumors with a high LI. The histologic groups of tumors with a high mean LI are on the average more radiosensitive and more sensitive to drugs.


Mathematic models of cell synchrony and drug scheduling.


Rapid methods for utilizing cell kintics for treatment in the C3H/He spontaneous mammary tumor: effects of vincristine.


Combined effect of cytosine arabinoside and thiopurines. Dose and time survival for leukemic colony-forming units (LCFU) and normal hematopoietic colony-forming units (NCFU) were obtained after the administration of either 6-mercaptopurine (6-MP) or 6-thioguanine (TG). Survival decreased to a plateau level with increasing doses as expected with phase-specific agents. Time survival curves demonstrated increased killing of LCFU after administration of 2 mg of 6-MP/mouse or 0.1 mg of TG/mouse reaching a minimum by 3-8 hours with repopulation therafter. Cytosine arabinoside (Ara-C) (1 mg/mouse) was combined with each agent, and the effects of sequence and interval were examined in terms of LCFU and NCFU survival. When Ara-C and either thiopurine were administered together, fractional survival was less than additive. However, as the interval was increased for either sequence and for both combinations, survival decreased to synergistic levels. Variation in dose of Ara-C and TG showed an inhibitory effect to be dependent upon the Ara-C dose. A correlation between results from the colony assay for for LCFU and survival of treated tumor-bearing mice was demonstrated for Ara-C plus TG. The results of these experiments are interpreted in terms of the proliferation kinetics of L1210 and the cellular effects of the agents; their clinical implications are discussed.


Kinetic aids to proper chemotherapeutic scheduling: labeled nucleoside incorporation studies in vivo.


Investigations on pharmacologic induction of partial synchronization of tumor cell proliferation: its relevance for cytostatic therapy.


Comprehensive view of the creative process in psychopathological art. Behavioral aspects in the art room.


Special technics in renovascular surgery. Apart from the critical selection of patients, surgical results in renovascular surgery depend mainly on technical problems. To overcome most frequent technical handicaps, such as a deep abdominal cavity, intervening structures, additional distal stenoses and limited ischemic tolerance time, several technical principles may be recommended. An anterior transperitoneal approach usually ensures an optimal exposure. The 'one-field repair' and the 'partial ex situ repair', include the advantage of excellent exposure and a superficial operating field. Particularly in cases of renal artery stenosis of the fibromuscular type, the routinely performed distal 'run-off control' by mechanical dilatation of the arterial branches, allows a high degree security. As in other fields of surgery, renovascular interventions should be directed to the principle of technical simplicity. Following this surgical concept there is only limited indication for the use of 'total ex situ repair' with heterotopic kidney replantation. We feel that this major time-consuming procedure has only a very small place in renovascular surgery, but a very real place in the correction of intrarenal lesions.


Results of medical and surgical treatment in renovascular hypertension. Long-term results and choice of antihypertensive drugs. 107 patients have been operated upon for atherosclerotic or fibromuscular renal artery stenosis from January 1, 1962 through December 31, 1973. At the time of last follow-up, or at 1 year 67% of patients with atherosclerotic renal artery stenosis, and 79% of patients with fibromuscular renal artery disease were considered to be improved. More recently 50 patients have been treated by surgery (24 patients) or with antihypertensive drugs. 70% (17 of 24) surgically treated patients and 61% (16 of 26) medically treated patients were improved after an average of approximately 1.5 years follow-up.


Cooperatives study of renovascular hypertension. Clinical characteristics, diagnostic tests and results of surgery.


The kidney after removal of one renal artery stenosis in the rat.


Proceedings of the Symposium on Cell Kinetics and Cancer Chemotherapy (Annapolis, Maryland, November 4-6, 1975): Introduction to session on drug scheduling--clinical studies.


Renin, renin substrate and angiotensin II concentration in renal venous blood. In 22 hypertensive patients with unilateral renal artery stenosis (RAS) and in 8 patients with unilateral or bilateral renal or renal arterial disease, plasma renin activity (PRA), renin substrate (PRS), and angiotensin II (AT II) concentrations were measured in both renal veins and in a peripheral vein 1-2 h after stimulation of renin secretion by injection of frusemide. In patients with elevated PRA in venous blood from a kidney with RAS, AT II was either also elevated, lower than or equal to PRA in peripheral blood, while the contralateral kidney almost invariably extracted AT II. In the 8 patients with variable renal diseases, the concordance between PRA and AT II measurements was better. Results suggest that AT II measurements in renal venous blood are less useful in assessing the functional significance of a RAS than those of PRA. Since PRS is not different in venous plasma of the diseased and the normal kidney, PRA measurements can be regarded as proportional to plasma renin concentration in this condition.


Pathophysiological concepts of renovascular hypertension.


Special patterns of renovascular hypertension.


Renovascular hypertension in children.

Renovascular hypertension in children.


Renin activity, renin secretion rate and renal hemodynamics as functional tests renovascular hypertension.


Measurement of plasma renin concentration and angiotensin II in peripheral and renal venous plasma in the management of renovascular hypertension. Athough in general, measurement of renal vein renin appears to give a good prediction as to the subsequent response to surgery, its main value lies in its ability to reflect changes in renal plasma flow; true changes in renin secretion rate being much more difficult to detect. Although it is a little early to say how much information can be derived from saralasin infusions, caution must be exercised in necessarily assuming that the test accurately reflects subsequent surgical response.


Saralasin (1-sar-8-ala-angiotensin II): pharmacology and clinical use in angiotensin-dependent hypertension.


Angiographic aspects of renovascular hypertension. Angiography is the most important diagnostic procedure for evaluation of renovascular hypertension. Technique and limits of this method as well as possible ways of improving its diagnostic value are discussed. The pathogenetic significance of a renal artery stenosis in hypertension and the prognosis for a vascular surgical intervention is discussed in the light of bilateral renin determination and the 138 Xe method of measuring intrarenal hemodynamics.


Pathology of renovascular hypertension.

Pathology of renovascular hypertension.


Extracorporeal renal surgery for renovascular hypertension. Nine cases of renovascular hypertension caused either by lesions in the distal part of the renal artery or by proximal renal atery stenosis where local reconstruction was considered dangerous were treated by extracorporeal reconstructive surgery and autotransplantation. The kidney were removed, cooled and preserved by simple hypothermia during workbench reconstruction on a separate side table. After reconstruction the kidneys were reimplanted to the groin. One kidney was lost due to infection and bleeding. All patients were preoperatively severely hypertensive. Blood pressure was normalized in all cases but one with a homotransplanted kidney which also was undergoing chronic rejection. The method is simple and safe and offers new possibilities to treat lesions in the kidney which previously were impossible or very risky to treat surgically. It is a safe alternative to conventional methods in case of anatomical structures making local reconstruction difficult.


Active infective endocarditis: a clinicopathologic analysis of 137 necropsy patients.


Relevant diagnostic procedures in renovascular hypertension. The validity of invasive preoperative diagnostic procedures in patients with unilateral renovascular hypertension was assessed. A significant lowering of blood pressure following reconstructive surgery can be predicted if following stimulation with Dihydralazine the renal-venous renin ratio of the involved to the noninvolved kidney is at least 2.0. Furthermore, it is of importance to determine the renal perfusion rate in the contralateral non-stenotic kidney which should be within normal limits. If these two criteria are met then in the majority of cases surgical intervention in unilateral hypertension is meaningful.


Polyploidization in rat liver: the role of binucleate cells. Liver cells were isolated from rats undergoing active formation of tetraploid cells and prelabelled in their DNA with 14C thymidine. Autoradiography of the isolated cells showed that binucleate diploid cells, a major component of the parenchymal cell population at this time, are also active in DNA synthesis. These cells probably pass through mitosis and generate mononucleate tetraploid cells, the dominant cell type of mature rat liver, since the frequency of binucleate tetraploid cells is very low at this stage in rat liver development. The biological significance of liver polyploidy is discussed and it is suggested that this lies in enhanced resistance to mutagenesis.


Transcriptional and post-transcriptional control of rRNA synthesis in human liver cells cultured in presence of L-triiodothyronine. The synthesis of rRNA in cultured human liver cells grown in the presence of L-triiodothyronine (1.6 x 10(-5)M) was measured by means of polyacrylamide gel electrophoresis using a double labelling technique. The rate of accumulation of rRNA in the cytoplasm as well as the turnover of rRNA in ribosomes remained unchanged in comparison to control cells regardless of growth stage or cell population density. L-triiodothyronine, however, induced an increased synthesis of rpreRNA when added in the early growth phase of sparse cultures. This induction was time dependent and occurred temporarily, but it was never followed by a similar accumulation of mature rRNA. Therefore, in this system two control mechanisms counteracting each other were effective: the increased rpreRNA synthesis indicates a transcriptional control, and the wastage of odd rpreRNA, however, a post-transcriptional control.


Shape changes and reduced calcium level in the surface membrane region of human platelets exposed to manganese in vitro. The effect of exogenous manganese ions upon human platelets in vitro has been studied. Morphological changes reported include the loss of discoid shape, increase in filopodia and close apposition of platelet surfaces. Electron microscope X-ray microanalysis of thin-sectioned material revealed a significant decrease in the bound calcium levels of the surface membrane as a result of manganese treatment. Analysis of whole platelet homogenates using atomic absorption spectrophotometry indicated that the total internal platelet calcium content had increased significantly. It is suggested that manganese induces the observed changes by displacing calcium from the regulatory system of an actomyosin-like protein complex at the periphery of the platelet.


Manometric studies during ERCP and endoscopic papillotomy.


An improved flexible cholangioscope.

An improved flexible cholangioscope.


Results of diagnostic pelviscopy in cases of chronic recurrent pelvic disease. During the last two years we have performed diagnostic pelviscopy in 90 patients suffering from a syndrome of chronic repeated pelvic disease. In 44 patients extragenital endometriosis was diagnosed as the causing factor. In 15 cases we found wide-spread adhesions in the region of the lower pelvis after preceeding laparotomies. Only in 12 patients pelvic-alterations caused by chronic inflammatory processes of the adnexa with peritubal adhesions were discovered. As these results show extragenital endometriosis represents in far more cases as generally believed the cause of gynecological pains. We want to give special emphasis to the diagnosis and treatment of this disease.


Technique, indication and evidence of sinuscopy. It is reported on experiences made with endoscopy of the maxillary sinus by means of three different angular optics according to Hopkins (0 degree, 30 degrees, 70 degrees). A sinuscopy is indicated in order to obtain an early diagnosis of malignant tumour growth; it is decisive as to an operation of the maxillary sinus to be carried out; it clarifies clinically uncertain maxillary sinus findings. In addition to the usual investigation methods, the sinuscopy allows a direct local diagnosis. Moreover, diagnostic and therapeutic operations may be carried out by means of a biopsy forceps.


Color and transmittance of human amniotic membranes.


Removal of foreign bodies from subsegmental bronchi with the fiberbronchoscope. Though the fiberbronchoscope has been designed for diagnostic purposes, it can be used, as well, for the removal of small foreign bodies from segmental and subsegmental bronchi; In this paper we report two cases in which we successfully removed from subsegmental bronchi a pulp-canal reamer and a melon seed. This fact proves that in some of these cases we can avoid thoracotomies.


A new self-twisting polypectomy snare.

A new self-twisting polypectomy snare. In contrast to the hitherto available polypectomy snares the newly designed snare for endoscopic polypectomy offers the following advantages: when the tip of the endoscope is directed towards the polyp the snare turns automatically into a position parallel to the polyp-bearing bowel wall. "Combusting ulcers" are avoided, a homogenous circular flow of electric current is guaranteed.


Colonoscopic perforation: its emergency treatment. One of the accepted complications of colonoscopy is perforation. This is known to occur in greater frequency in patients having undergone previous pelvic or colonic surgery, as well as patients suffering from diverticulosis. A case is presented of colonic perforation during diagnostic examination in an area of adhesions secondary to pelvic surgery. Immediately after the perforation, the patient entered into vascular collapse and respiratory distress, with a distended abdomen. The introduction of a large bore intravenous catheter into the abdominal cavity with the release of the pneumoperitoneum resulted in an instantaneous return of vital signs and the patient subsequently underwent surgery and recovered. It is felt that this method of emergency treatment can be life-saving in a patient perforating during colonoscopy.


A new device for endoscopic foreign body extraction. A yoghurt-spoon with a long handle which could not be removed initially from the stomach during several sessions was finally successfully extracted by a new simple device.


Oesophagus bezoar diagnosed and removed endoscopically. The authors describe the rare case of bezoar in the oesophagus. Their patient was sent to their Clinics with a diagnosed oesophageal tumor. The exact diagnosis was established by endoscopical examination. The bezoar was removed by endoscope, therefore, an operation was not necessary.


Double pylorus and esophageal achalasia. 29 cases of double pylorus have been reported so far. It is thought that in 85% of the cases it has been due to a fistulous gastro-duodenal ulcer and the remaining 15% would be of a congenital origin. In the case we have reported the double pylorus is believed to be a congenital anomaly associated with a mega-esophagus of similar etiology.


Transgastroscopic ultrasonography.

Transgastroscopic ultrasonography. A newly designed ultrasonography probe is presented which can be advanced through the instrumentation channel of an operative endoscope (TGF-Olympus). The A-scan allows the differentiation between solid and cystic masses in the upper abdomen leading to gastric impression. Guided puncture of pancreatic pseudocysts is based on a solid diagnosis and can be performed from the gastric lumen thus avoiding the development of pancreato-cutaneous fistulas.


Quantitative analysis of styrene monomer in polystyrene and foods including some preliminary studies of the uptake and pharmacodynamics of the monomer in rats. A variety of food containers, drinking cups and cutlery, fabricated from polystyrene (PS) or polystyrene-related plastic, were analyzed for their styrene monomer content. Samples of yogurt, packaged in PS cups, were similarly analyzed and the leaching of styrene monomer from PS containers by some food simulants was also determined. Blood level studies with rats, dosed with styrene monomer by various routes, illustrated uptake phenomena that were dependent on the dose and route of administration and were also affected by the vehicle used to convey the styrene monomer.


A case of common bile duct ascariasis diagnosed by duodenoscopy. A case of common bile duct ascariasis diagnosed by duodenoscopy is presented. At the admission, the patient, cholecystectomized for gallstones 13 years before, had been complaining of epigastric pain associated with post-prandial and nocturnal vomiting. Physical examination showed only slight tenderness in the epigastrium. Laboratory findings were within normal limits, with the exception of a moderate leukocytosis. Intravenous cholangiography showed the lack of visualization of the terminal common bile duct, but the flow of contrast medium was normal. Duodenoscopy, carried out without a specific clinical suspicion, revealed an ascaris lumbricoides inserted in the common bile duct and partially protruding from the papilla Vateri. The patient was treated by piperazine, intravenous fluids, antibiotics and a choleretic compound. After 24 hours an ascaris 33 cm long was excreted in the faeces and the patient became symptom-free. Some pathophysiological, clinical and epidemiological aspects of biliary ascariasis are discussed.


Measurement of some potentially hazardous materials in the atmosphere of rubber factories. Two separate topics of work are outlined: methods for the measurement of chlorinated monomers in PVC and polychloroprene, and also methods for the measurement of these materials in factory air. Typical results which have been obtained in supplies of raw materials, in finished products, and in the working atmosphere at manufacturing operations are given. The second topic concerns the measurement of benzo[a]pyrene in the atmosphere of a tire manufacturing plant. This material is present in trace quantities in the mineral oils and carbon blacks used by the industry. The atmospheric concentrations present at various processes in this plant were measured on a daily basis over a period of two years, and the results obtained compared with results taken concurrently from an outside air station. It is shown that no significant quantities of benzo[a]pyrene are produced by tire manufacturing operations.


Hypogammaglobulinemia with lymphoid nodular hyperplasia of the small bowel: endoscopic diagnosis of one case. A 37-year-old man suffering from abdominal pain and diarrhea, was hospitalized because of abdominal discomfort. Gastroduodenal series showed multiple duodenal filling defects. Gastroduodenoscopic examination revealed numerous nodular lesions in the duodenum and biopsy specimen demonstrated nodular lymphoid hyperplasia. The serum immunoelectrophoretic pattern showed a virtual absence of IgA and IgM and a very decreased level of IgG. To our knowledge, it is the first case of hypogammaglobulinaemia with nodular hyperplasia of the small bowel, diagnosed by endoscopy and forceps biopsy.


The endoscopic demonstration of coeliac disease. The first part of the duodenum has been studied endoscopically in treated and untreated coeliac patients. Biopsies taken from the duodenal cap during endoscopic examination, show villous atrophy similar to that found in the distal duodenum and jejunum. Using the indigocarmine scattering method, severe atrophy of the mucosal surface can be demonstrated throughout the duodenal cap, in vivo, in untreated coeliac disease.


Proceedings of the WHO-NIEHS conference on potential environmental health hazards from technological developments in rubber and plastics industries. Research Triangle Park, N.C., March 1-3, 1976: Introductory statement.


Dose-dependent fate of vinyl chloride and its possible relationship to oncogenicity in rats. Studies on the fate of 14C-labeled vinyl chloride (VC) following oral administration and inhalation exposure in rats demonstrated that the disposition of VC in the body is a function of the dose. More importantly, from the data available, it appears that a correlation exists between doses of VC which cause tumors and those that saturate metabolic or detoxifying pathways. Additional studies characterized the depression of liver non-protein sulfhydryl content (primarily GSH) with the duration and concentration of exposure to VC. The results of these investigations indicate that statistical projections utilizing data collected from rats exposed to high doses of VC are invalid for predicting the hazard of low level exposure, because such projections violate a priori assumption that the dynamics governing the fate of VC in the body are unaltered.


Chronic diseases in the rubber industry. An overview is presented of epidemiologic studies of chronic diseases in the rubber industry. Analyses of the mortality experience during the period 1964-1972 of workers age 40-64 and retirees age 65-84 of two large rubber and tire manufacturing companies consistently disclosed excesses of deaths attributed to leukemia and lymphosarcoma, and for cancers of the stomach, large intestine, and prostate. The relation of site-specific malignancies to work histories and grouped occupational titles as surrogate measures of work-related exposures to possible carcinogens is described. There was no evidence of company-wide, sizable, consistent excess for the other major chronic diseases causes of death. Although a total cohort deficit in the mortality rate for lung cancer was found, there was a history of increased frequency of exposure to certain work areas among lung cancer decedents. Morbidity studies, including analysis of disability retirements, and ad hoc questionnaire and health testing surveys, disclosed excesses of chronic pulmonary diseases. There was evidence of an interactive effect in the association of work and smoking histories with pulmonary disability retirement.


Endoscopy in experimental urology using an argon-laser beam. For the first time cystoscopic argon and neodymium-YAG laser irradiation of the bladder wall using a flexible quartz fiber light guide (as described by Nath) was studied morphologically and histologically. It was seen that it is possible to control the depth of tissue removal without the risk of perforation of the bladder wall. Therefore endoscopic surgery of bladder tumors by laser radiation seems to be possible. Hydronephrosis could not be observed even after direct laser irradiation of the orifices.


Hepatic and extrahepatic metabolism of 14C-styrene oxide. With 8-(14)C-styrene oxide as substrate, specific glutathione S-transferase and epoxide hydrase activities were determined in subcellular fractions of liver, lungs, kidney, and intestinal mucosa from rabbit, rat, and guinea pig. Liver had the highest enzyme activities in each species. Rat and guinea pig had higher glutathione S-transferase activity in both liver and kidney than rabbit. Rat testis also had appreciable glutathione S-transferase activity. The perinatal development of epoxide hydrase and glutathione S-transferase was followed in liver and several extrahepatic tissues of fetal and neonatal guinea pigs and rabbits. The rates at which enzyme activities reached adult levels in the extrahepatic tissues differed from the liver in both species. Epoxide hydrase and glutathione S-transferases developed at different rates in each organ, demonstrating that the relative importance of these two detoxifying pathways for styrene oxide may shift before and after birth. The effects of pretreating male and female rats with phenobarbital (PB), 1,2,3,4-dibenzanthracene (DBA), pregnenolone-16alpha-carbonitrile (PCN), or 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on hepatic and extrahepatic epoxide hydrase and glutathione S-transferase activities toward styrene oxide were determined. PB increased both enzyme activities in liver of both sexes. PCN induced only glutathione S-transferase activity in female liver. Extrahepatic epoxide hydrase and glutathione S-transferase activities were unaffected except that TCDD doubled female renal epoxide hydrase activity and PB increased intestinal epoxide hydrase activity in both sexes. Styrene oxide biotransformation was studied in isolated, perfused rat liver and rabbit lung preparations. Conjugation with glutathione was a major metabolic pathway although significant amounts of diol were also formed in each instance. In rat liver, 27-40% of the administered styrene oxide was excreted via the bile mainly as S-(1-phenyl-2-hydroxyethyl)glutathione.


Demographic variation in cancer in relation to industrial and environmental influence. Mortality data (183,064 deaths in a 30-year period, 1940-1969) by sex and three ethnic groups (white excluding Spanish-surnamed, nonwhite, and Spanish-surnamed) in 15 regions within the city (Houston), grouped around the air pollution sample collection stations have been analyzed. Valid contrast studies were possible in only one region within the city for all three groups and in six regions for white excluding Spanish-surnamed and nonwhite. There is evidence that the environmental factors of exposure over time to air and industrial pollutants in Houston has had a demonstrable effect in increasing regional mortality from cancer of the respiratory tract as well as from all other diseases and conditions of the respiratory tract and heart disease. This study points out the need for mutually sustained collaboration of effort of the scientific and industrial communities to redirect their attention and research efforts to the exploration of the carcinogenic potential of the microchemical environment.


Mortality and cancer morbidity in a group of Swedish VCM and PCV production workers. The cohort of workers employed in a Swedish vinyl chloride/poly(vinyl chloride) plant since its start in the early 1940's has been followed for mortality and cancer morbidity patterns. Only 21 of the 771 persons could not be traced. Difficulties in establishing exposure levels at different work areas in the past makes an evaluation of dose-effect relationships impossible. A four- to fivefold excess of pancreas/liver tumors was found, including two cases later classified as angiosarcomas of the liver. The number of brain tumors and suicide do not deviate significantly from expected. Cardiovascular and cerebrovascular diseases, on the other hand, differ significantly from the expected. The discrepancies between previous reports on VCM/PVC workers and this report are discussed. The possible etiology of the cardiovascular deaths is also discussed.


Clinical studies of styrene workers: initial findings. Styrene monomer is a high volume chemical used chiefly in production of polystyrene. A clinical survey of 493 production workers was undertaken at the oldest and largest monomer production, polymerization, and extrusion facility in the U.S. Relative exposure durations and levels were obtained from occupational histories. Significant differences between the high and low exposure groups were found with regard to history of acute prenarcotic symptoms, acute lower respiratory symptoms, prevalence of FEV 1/FV less than 75 per cent, and elevated GCTP. Other liver function tests, chest x-ray, FVC less than 80 per cent, and hematological parameters showed no distinct pattern. A concomitant mortality study has been mounted and is in progress.


Malignant tumors of the liver and lungs in an area with a PVC industry. The incidence of malignant tumors of the lung and bronchus and of cytologically confirmed primary malignant tumor of the liver was analyzed for a 4-yr period in a city with several factories, including a PVC industry. Prior to the study two cases of angio-sarcoma of the liver were diagnosed in workers employed in PVC production. The total incidence of analyzed tumors was only slightly higher than predicted. The tumors of the liver recorded did not show any dependence on place of work or residence. During the period of observation, malignant tumors of the bronchus (lung) were not recorded in the PVC industry. Their rate in the area in which the PVC industry is situated was approximately the same as that for the entire city area. The study does not indicate that the occurrence of malignant tumors other than angiosarcoma is associated with exposure to vinyl chloride.


Health hazards in the production and processing of some fibers, resins, and plastics in Bulgaria. Results of the toxicological studies of working conditions, general and professional morbidity, and complex examinations carried out on workers engaged in the production of polyamides, polyacrylonitrile fibers, polyester fibers and poly (vinyl chloride) resin, urea-formaldehyde glue, glass fibre materials and polyurethane resins are given. An extremely high occupational hazard for workers in the production of poly (vinyl chloride) resin and porous materials from polyurethane resins and urea-formaldehyde glue has been established. Cases of vinyl chloride disease, poisoning from formaldehyde, isocyanates, and styrene were noted. Prophylactic measures were taken in Bulgaria to lessen the occupational hazard in the productions as set forth included limitation of the work day to 6 hr, free food, additional bonus and leave, and annual physical examinations of workers.


Recent progress in safety evaluation studies on plasticizers and plastics and their controlled use in Japan. Recent experimental studies in Japan on the evaluation of potential health hazards from phthalate esters used in manufacturing poly (vinyl chloride) as well as several plastics for medical devices and for food containers and packages were introduced. Development of pulmonary granuloma formation after intravenous injection of diethylhexyl phthalate was assumed to be dependent on the particle size of the phthalate in vehicle used. Dietary administration of large amount of diethylhexyl phthalate and dibutyl phthalate produced renal cysts in mothers and in descendants in reproduction studies in mice. Cytotoxicity and mutagenicity of the phthalates and several plastics and resins were also examined by in vivo and in vitro studies. Hematological parameters examined in rabbits after repeated intravenous injection of diethylhexyl phthalate and after implantation of plastics in aorta for 3--6 months did not show any significant change. A slow decrease of radioactivity was observed in adipose tissue of rats following oral administration of 14C-labeled diethylhexyl phthalate. tthe administrative action on phthalates by the Japanese Ministry of Health and Welfare is briefly reviewed.


Problems and perspective in epidemiological study of occupational health hazards in the rubber industry. An epidemiological analysis of the problems in the study of companies engaged in the manufacture of rubber products in different countries and in different time periods is given. Selected findings on cancer of gallbladder and biliary system, cancer of the lung, and tumors of the central nervous system among rubber workers are presented.


Studies on the metabolism of vinyl chloride. Vinyl chloride (VCM) is not carcinogenic by itself, it is bioactivated to the highly reactive alkylating oxirane chloroethylene oxide. Further metabolism, apparently, leads via an interaction of the primary alkylating metabolites with glutathion to S-(2-carboxy-methyl)-cysteine and thiodiacetic acid which are eliminated with the urine. Up to now, it has not been ascertained whether the oxirane alone is the essential carcinogenic factor or whether other metabolites are also involved in carcinogenicity. Likewise, it is still unknown whether the metabolites excreted in the urine might be used as biological criteria for exposure to VCM, because these metabolites probably can originate from a series of substances other than VCM. This problem could stimulate investigations on the possible carcinogenic activity of these substances.


Consumer hazards of plastics.

Consumer hazards of plastics. The modern consumer is exposed to a wide variety of plastic and rubber products in his day to day life: at home, work, school, shopping, recreation and play, and transport. A large variety of toxic sequellae have resulted from untoward exposures by many different routes: oral, dermal, inhalation, and parenteral. Toxic change may result from the plastic itself, migration of unbound components and additives, chemical decomposition or toxic pyrolysis products. The type of damage may involve acute poisoning, chronic organ damage, reproductive disorders, and carcinogenic, mutagenic and teratogenic episodes. Typical examples for all routes are cited along with the activites of Canadian regulatory agencies to reduce both the incidence and severity of plastic-induced disease.


Recent achievements and research initiated in the Swedish plastics and rubber industry. The improvement in exposure conditions in the Swedish vinyl chloride producing industry is reported. The article comments on the technology and control methods by which the vinyl chloride concentration has been lowered to less than 1 ppm vinyl chloride. Two epidemiological retrospective cohort studies are presently under way on workers in PVC-utilizing industries and in the rubber industry.


Diffusion of residual monomer in polymer resins. A simplified mathematical model which made use of Fick's laws of diffusion written in spherical coordinates was developed to describe the rate of diffusion of residual monomers from polymer resins. The properties of the monomer-polymer system which influenced the amount of monomer remaining in the polymer as a function of time were the diffusivity and solubility of the monomer in the polymer, and the particle size of the polymer resin. This model was used to analyze literature data on the diffusion of residual vinyl chloride monomer in polyvinyl chloride resins made by the suspension process. It was concluded that particle size of the resin was a significant parameter which should be taken advantage of in process equipment designed to remove residual monomer from PVC resins. The diffusivity of the monomer in the polymer was a function of the solubility of the monomer in the polymer. Monomer solubility can be determined from Henry's law. It was suggested that this model could be adapted to describe diffusion of monomers from any monomer-polymer system, and would be a useful approach to modeling the transport of nonreactive chemical additives from plastics.


Difficulties of forecasting health implications.


Proceedings of the WHO-NIEHS conference on potential environmental health hazards from technological developments in rubber and plastics industries. Research Triangle Park, N.C., March 1-3, 1976: Concluding remarks.


Criteria for the health evaluation of polymeric materials building. Various polymer-based synthetic materials have become increasingly ubiquitous in manufactured materials in the U.S.S.R. These release various chemical compounds to the ambient air. The maximum permissible concentrations that have been established for various hazardous chemicals in ambient air must be adjusted to account for the conditions of apartment life. Studies have been conducted to determine exactly what compounds are released and at what rate. Toxicological studies and studies of various physical and chemical properties are required to determine the health effects of these chemicals at concentrations at which they are expected to occur in apartments. More research has to be carried out in this field to further expand our knowledge, and we must beware of any introduction of new polymeric materials without first studying their contribution to possible detrimental health effects.


Occupational disease in the rubber industry. We have studied mortality patterns in a large cohort of rubber workers. We have examined workers exposed to curing fumes, processing dusts, and industrial talc and have begun to evaluate exposures of these workers in detail. Gastrointestinal (especially stomach) cancer appears in excess in processing workers. Lung cancer is excessive in curing workers. Leukemia is increased generally. All three groups studied for respiratory disease have an increase in disease prevalence which is related to intensity and duration of exposure. Since both an increase in stomach cancer and respiratory disease is seen in processing workers, exposures in this area must be controlled. Since both lung cancer and chronic respiratory disease is excessive in curing rooms, this exposure must be controlled. The leukemia risk is probably related to solvents. Whether this is all explainable by past benzene exposure is unknown. Further studies are planned to refine our knowledge concerning these risks so that occupational disease in the rubber industry can be prevented.


Neurotoxicity and behavioral effects of thiram in rats. Eight of 24 female rats fed 66.9 mg/kg-day of thiram developed neurotoxicity. The neurotoxic effects were characterized by ataxia and paralysis of the hind legs. There were demyelination, degeneration of the axis cylinders, and presence of macrophages in the nerve bundle of the sciatic nerve. Degeneration in the ventral horn of the lower lumbar region of the spinal cord was evidenced by chromatolysis of motorneurons, pyknosis, and satellitosis. During a second experiment, 4 of 24 females fed 65.8 mg/kg--day also developed ataxia and paralysis. An additional 9 females showed clasping of the hind feet when picked up by the tail. Nerve conduction could not be measured for one severely ataxic rat and the electromyogram indicated a loss of motor unit function. Histopathology of this rat, along with the others, suggests the peripheral nerve as the primary site of the lesion. Thiram also caused behavioral changes in apparently normal rats. The walking pattern of the hind legs was altered with decreases in stride width and the angle between contralateral steps. These rats required significantly more shock-motivations and cleared a lower height in a jump/climb ability test. An open-field study indicated that thiram caused hyperactivity in the nonataxic rats of both sexes. Three of 24 rats fed 95.8 mg/kg-day of ferbam also developed ataxia or paralysis.


Priorities in the investigation of human health hazards in the plastics and synthetic rubber industries. Experiences in the past decade provide guidance in selecting priorities for investigation of health hazards in chemical industries. Pride of place should be given to the experience of large industrial populations, in part simply because large numbers of people are at risk and in part because such studies are more likely to give reliable answers. This recommendation has further strength when there is community exposure as well. Parenthetically, large populations provide opportunity to study multiple factor interaction; without this, toxic potential of a single agent may be obscured. Second, investigations should be mounted when there is reason for suspicion, as with particular chemical configurations, observed organ toxicity, animal carcinogenicity, unusual clinical experience ("signal" tumors). It may be added that when agents have already been used several decades, evaluation of human experience with them is now in order, if only to document absence of toxicity. The same recommendations hold for planned introduction of new agents or widened distribution of existing ones, until we have better information concerning validity of "pretesting" programs. Major advances have been made in epidemiological methods for these investigations. These now allow us to successfully focus on small defined groups as well as to manage large populations.


Chemistry and toxicity of flame retardants for plastics. An overview of commercially used flame retardants is give. The most used flame retardants are illustrated and the seven major markets, which use 96% of all flame-retarded polymers, are described. Annual flame retardant growth rate for each major market is also projected. Toxicity data are reviewed on only those compositions that are considered commercially significant today. This includes 18 compounds or families of compounds and four inherently flame-retarded polymers. Toxicological studies of flame retardants for most synthetic materials are of recent origin and only a few of the compounds have been evaluated in any great detail. Considerable toxicological problems may exist in the manufacturing of some flame retardants, their by-products, and possible decomposition products.


Toxicity of combustion products from burning polymers: development and evaluation of methods. Laboratory and room-scale experiments were conducted with natural and synthetic polymers: cotton, paper, wood, wool, acetate, acrylic, nylon, and urethane. Smoke and off-gases from single materials were generated in a dual-compartment 110-liter exposure chamber. Multicomponent, composite fuel loads were burned within a 100 m(3) facility subdivided into rooms. In chamber experiments, mortality depended on the amount of material burned, i.e., fuel consumption (FC). Conventional dose (FC)/mortality curves were obtained, and the amount of fuel required to produce 50% mortality (FC(50)) was calculated. With simple flame ignition, cotton was the only material that produced smoke concentrations lethal to rats; FC(50) values for cotton ranged from 2 g to 9 g, depending on the configuration of the cotton sample burned. When supplemental conductive heat was added to flame ignition, the following FC(50) values were obtained; nylon, 7 g; acrylic, 8 g; newsprint, 9 g; cotton, 10 g; and wood, 11 g. Mortality resulting from any given material depended upon the specific conditions employed for its thermal decomposition. Toxicity of off-gasses from pyrolysis of phosphorus-containing trimethylol propane-polyurethane foams was markedly decreased by addition of a flame ignition source. Further studies are needed to determine the possible relevance of single-material laboratory scale smoke toxicity experiments. Room-scale burns were conducted to assess the relative contributions of single materials to toxicity of smoke produced by a multicomponent self-perpetuating fire. Preliminary results suggest that this approach permits a realistic evaluation of the contribution of single materials to the toxicity of smoke from residential fires.


A comparative trial of the use of fish protein concentrate and cow milk proteins in the treatment of kwashiorkor.


Health aspects of the curing of synthetic rubbers. A commonly used tread rubber formulation was cured in the laboratory under conditions simulating vulcanization in the Bag-O-Matic press. Volatile emissions were collected on charcoal and analyzed by combined GC-mass spectrometry. The compounds identified were either contaminants present in the raw material or reaction products. Some of these compounds were also identified in charcoal tube samples collected in the atmosphere of the industrial operations. Estimates based on the loss of weight of rubber during curing were used to predict airborne concentrations and compared to the concentrations actually found. The literature of the toxicity of raw materials and effluents was reviewed, and no acute or chronic toxicological effects would be anticipated. Information concerning potential carcinogenicity was not available and could not be evaluated.


Intestinal parasitism in fifty communities on the central plateau of Ethiopia.


Neonatal septicaemia.

Neonatal septicaemia.


Congenital hypertrophic pyloric stenosis in Ethiopian infants.


Is elephantiasis on the lower legs a geochemical disease?


Management of sigmoid  volvulus with special reference to primary resection.


The family and the school: utilizing human resources to promote learning.


An exploration of the dynamics of the overlapping worlds of work and family. The relationship between the working lives and family lives of people in our society is a concern to both families and corporations. This article describes a research project that yielded theoretical statements about the interactions between organization life and family life for members of large corporations; grounded theory methodology and a systems theory approach were used. Data were obtained in a large multinational corporation from managers and their families who were undergoing three different kinds of organizational stress: international transfer, extensive travel, and job change to facilitator of personal and organizational change. The findings give reason for viewing organization and family as interacting systems and for considering the uniqueness of each individual's response to stressful events. They also indicate that an individual's feeling of influence over stressful events at the organization-family boundaries are significant for both organizational and family effectiveness.


Individuation: from fusion to dialogue.

Individuation: from fusion to dialogue. Growing interest in concepts of fusion and individuation within a number of different theoretical systems of psychotherapy suggests an emerging shift in perspective in the conceptualization of psychopathology and psychotherapy. This shift may represent a first step in the integration of individual and relational dynamic theories. A theoretical framework for the exploration of processes of fusion and individuation is presented, with suggested applications for the study of problems experienced by adult couples. The process of individuation from fusion to dialogue is outlined in the description of four modes of relationship. In this context, the paper suggests ways in which a variety of problematic relational patterns seen in couples may be viewed as reflecting the partners' struggles to move from fusion to dialogue.


Family therapy in treatment of the deaf: a case report. Deaf patients with psychological problems have developmental handicaps and clinical characteristics that reduce the effectiveness of traditional modes of psychotherapy. Attempts have been made to utilize individual and group therapy, but family therapy has been largely overlooked as a method of alleviating problems of the deaf. Clinical and research writings provide us with rich insights into the family dynamics of the deaf. These data suggest to the authors that the problems of deaf individuals are largely related to family problems, and therefore merit a family orientation as the focus for treatment. This paper describes an attempt to apply family therapy with a range of deaf patients over a period of two years. From a review of their work, the authors conclude that family therapy can be effective, particularly in the treatment of deaf adolescents and children.


Experimenting with family treatment approaches to alcoholism, 1950-1975: a review. The attention given family therapy approaches to alcoholism has been disproportionately low in relation to the magnitude of alcohol abuse as a clinical problem and its acknowledged impact on family life. Although the literature to date is limited and most studies should be characterized as pilot in nature, preliminary results have enthusiastically endorsed family therapy approaches to alcoholism. This critical review assesses the existing experimental and clinical literature of the pase 25 years. It also offers potential explanations for the reluctance of family therapists to engage this problem more actively.


A method for co-therapy for schizophrenic families. This paper describes a model of treatment for families in which one child has been given the diagnosis of schizophrenia. Male and female therapists adopt structured roles that are used as a paradigm for exploring family patterns. The paradigm employs a three-generational hypothesis that defines schizophrenia as a lifelong, restricting mode of relating, involving the primary family triad, that makes the child vulnerable to repeated psychotic episodes. Therapy is directed at the difficulties of autonomous development within the family by focusing on differentiating the relationship between nuclear and extended family members, expecially defining and strengthening generational and sexual boundaries. The second focus of therapy is on the resolution of issues of separation and loss, with attention to unresolved mourning in the family of origin and the concomitant stress in giving up the infantile relationship with the index child in the nuclear family. Stages of therapy will be described including: (a) initiation of therapy, (b) breaking of fusion, (c) repair of alienation, and (d) solidifying the marital alliance and generational boundaries. Case illustrations will be included.


Family of origin as a therapeutic resource for adults in marital and family therapy: you can and should go home again. This paper presents a general method of involving adults who are in marital and family therapy in sessions with their family of origin, offering a clinical application of the author's depth theoretical orientation. The method is based on the thesis that current marital and family difficulties are elaborations of relationship problems of the spouses in their original families. If adults are able to go back to deal directly with past and present issues with their families or origin, an opportunity exists for reconstructive changes to come about in their present family. This present work is compared with Bowen's methods. Procedures are outlined for preparing for these sessions and for overcoming resistances. Typical courses these sessions tend to take are described, and some preliminary results are presented. Several case histories are presented, and theoretical and clinical implications of this method are discussed.


The product of the consensus Rorschach in families of male schizophrenics. A consensus Rorschach was given to the families of 36 male schizophrenics, 13 psychiatrically hospitalized nonschizophrenic controls, and 38 normal controls with the goal of discriminating the families of schizophrenics from the other two groups of families. After the family agreed on a response, each member was asked to write the response on a separate sheet of paper. This study focused on these written responses, the product of the interaction, rather than on the process of reaching agreement. A system was developed to score the responses based on the degree of shared meaning achieved by the family. Adequate interscorer reliability was obtained. The scores significantly differentiated the three groups. More families of schizophrenics had low scores indicating lack of shared meaning than families of hospitalized and normal controls. In the normal control group, more upper-class families had high scores than lower-class families, wheras in the schizophrenic group there was a trend in the opposite direction.


Non-pulmonary tuberculosis in Ethiopian medical in-patients.


Isolation and biochemical properties of toxic tryptic peptides of ricinotoxin from Ricinus communis seeds. Tryptic hydrolysis conditions of ricinotoxin were studied in order to produce not only digestion of this glycoprotein but also still toxic tryptic peptides. No hydrolysis was obtained without prior denaturation. The best conditions of denaturation were obtained with 0.2 M guanidine hydrochloride and, to a lower extent, by heat treatment at 90 degrees C during 6 minutes. The hydrolysates were fractionated on Sephadex G100 column. In each case highly toxic peptide fractions were obtained which showed, like native ricinotoxin, a strong inhibitory action on the in vitro protein synthesis ina cell-free eukaryotic system but were without any action on a prokaryotic cell-free system.


Problems in measuring the success of family therapy in a common clinical setting: impasse and solutions. Families treated in conjoint therapy in the outpatient clinic of a general community hospital for about a year and other families that refused further contact with the same clinic after no more than two interviews were followed up about four and a half years later. The main difference found was that the treated group reported more new symptoms. The complexities of interpreting the data obtained are used as a basis for discussing problems that confront, and may deter, clinics attempting to evaluate their clinical work by means of controlled, nonfactorial or related designs. Process or correlational studies are suggested as an alternate choice.


The incest taboo and family structure.

The incest taboo and family structure. The evolutionary advantage of outbreeding has influenced the family structure and the mating, attachment, and dominance behaviors of all animals. Nature has selected for those species that have evolved family structures with detachment and dominance patterns that create a relatively intact incest barrier. Man inherits from his animal forebears the biological imperative of an incest barrier but brings to it his special complexity of psychology and symbolization--incest barrier becomes incest taboo. We present a discussion of human patterns of speparation-individuation and Oedipal conflict and relate this to the detachment and dominance behaviors of animals. This is an interface between psychoanalysis, family theory, and ethology. In addition, we pursue in detail the asymmetrical operation of the incest taboo within the family: that it is stronger for mother-son than for father-daughter than for brother-sister.


Balance theory: possible consequences of number of family members. This paper outlines one theoretical issue involved in considering the relationships that may exist in a family. The usual approach is to treat the family as a whole, made up of n members. The main issue here is the effects of the numerical size of the family and the many possible total and sub-total relationships that may exist within family constellations. Family structure and function is multivariate, but the focus here is the numberical factor.