An introduction to ethical theory.

An introduction to ethical theory.


Human rights and professional responsibilities.


Ethics and its application in health care.


Informed consent: information or exploration?


Coping with personal insularity.

Coping with personal insularity.


Case study: proxy consent: a case discussion.


Communication--a form of bias.

Communication--a form of bias.


Education research, but never on the curriculum.


Quality of interpersonal style among hospitalized psychiatric patients.


Care of the institutionalized aged in Scotland and the United States: a comparative study.


Technical notes: acquiescent response set: a source of measurement error.


Problems in doing research: planning for logical consistency among three research structures.


Ethical issues in nursing research: the institutional review board.


Clinical pathophysiology of mixed function oxidase system (MFOS) induction.


Strategies for teaching nursing research: placement of research content in the undergraduate curriculum.


Researchmanship: the arena.

Researchmanship: the arena.


Nurse practitioners', public health nurses', and physicians performance on clinical simulation test: COPD.


The research critique: a theoretical approach to skill development and consolidation.


Problems in doing research. Theoretical substruction: an assessment process.


Ethical issues in nursing research. The National Commission for the Protection of Human Subjects.


Strategies for teaching nursing research.


Researchmanship.

Researchmanship.


Cryptic plasmids in Enterobacteriaceae of the Bethesda-Ballerup group.


Studies on aminoacyl tRNA synthetases and transfer RNA in living Xenopus laevis oocytes. The microinjection of transfer RNA into amphibian oocytes permits one to study under in vivo conditions the reactions that affect this important macromolecule. A comparative study has been carried out between the in vivo and in vitro specificity of the aminoacylation reacton. The results obtained show that modifications of the tRNA structure affect aminoacyl-tRNA synthetase recognition in the same fashion in both conditions. The in vivo aminoacylation was not affected by the presence of puromycin (0.5mM) or cycloheximide (0.1 mM) which completely inhibited oocyte protein synthesis. An interesting difference was obtained between the in vivo and in vitro aminoacylation of tRNA with regards to temperature requirements. While the in vivo reaction was optimal at 25 degrees and was totally inhibited at 37 degrees, the in vitro was optimal, at the latter temperature. The inhibition of the in vivo reaction at 37 degrees was not due to inactivation of the enzyme. The transfer of the amino acid moiety to nascent proteins was studied by measuring the transfer of radioactivity from injected (14C) phenylalanyl-tRNA into hot trichloroacetic acid precipitable material. It was found that 30% or more of the amino acid became incorporated into oocyte proteins and that this incorporation was due to direct transfer from the aminoacyl-tRNA and was inhibited by puromycin and cycloheximide.


Management, assertiveness and the student role.


Assertiveness reduces body stress.

Assertiveness reduces body stress.


Assertive managerial functions.

Assertive managerial functions.


Assertion: traditional medicine/holistic health and husband/physician.


Breath: healing assertive power over mind and body.


Which do you assertively choose? Stress reduction and self-healing or stress?


Nursing, creative, assertive leadership and androgyny.


Clairemont Community Hospital: assertiveness.


Quality assurance is for nurses too!

Quality assurance is for nurses too!


Increasing nurse power in health development: "Let our voice be heard, let our presence be felt".


Perinatal infections. General discussion I.


Pathology of the placenta and cord in ascending and in haematogenous infection. The two main patterns of inflammatory response in the placenta and its adnexae are: (1) amniotic infection, usually bacterial ascending, with acute chorioamnionitis and funisitis; (2) haematogenous villitis, usually viral, with early necrotizing lesions and vasculitis and, later, chronic infiltrates and obliterative vasculitis. In amniotic infection most cells in the exudate are maternal. These leucocytes participate in antibacterial defence of the amniotic cavity in conjunction with substances such as zinc polypeptide and lysozyme and may contribute directly to fetal defence. Immunoglobulins may be produced in the cord of placenta only in protracted lesions such as 'healed' funisitis. Individual variations in the resistance of the membranes to bacterial penetration are possible. In viral infections a massive multifocal production by plasmacytes of immunoglobulins M, G and A is seen in affected villi. The secretion of non-specific antiviral substances in the infected placenta is possible. In all affected villi there is an activation of fixed macrophages (Hofbauer cells) that remain partly 'immature', i.e. are lysozyme-negative. Multifocal lymphoplasmacytic villitis is uncommon and has helped to focus the diagnosis on prenatal infection. In contrast, non-specific lymphocytic villitis is common; since there is no morphological difference between cases known to be associated with an infection, e.g. varicella, and the others, many cases may well be due to silent infection, although a graft-versus-host reactions remains a distinct possibility.


Nurses and unionism.

Nurses and unionism.


Prevalence of maternal and neonatal infections in a developing country: possible low-cost preventive measures. The frequency and duration of infectious illnesses in 408 pregnant rural women and 417 poor urban infants in Guatemala have been investigated, together with morbidity and mortality among the offspring of the rural women. Rural women suffered high rates of infection during the gestation period. Symptomatic illnesses, mainly acute respiratory infection and diarrhoeal disease, usually showed a higher incidence during the last months of pregnancy. Significant bacteriuria was identified in 21% of the women, though symptoms of urinary tract infection were found in about 25%. Vaginal infection was found in 38% of women at the beginning of pregnancy and in 79% at its end. Twelve per cent of women showed evidence of reactivated infections with cytomegalovirus, herpes simplex virus and Toxoplasma gondii. The neonatal mortality rate in the rural population was 37.7 per 1000 liveborn infants. Most deaths were among preterm babies. Significant bacteriuria was related to low birth weight. Morbidity in rural neonates was also high, but the illnesses were not severe and had a short duration. Neonatal morbidity in poor urban infants was also high. Breast-feeding had a protective effect: breast-fed rural and poor urban infants had a lower incidence of illness than urban babies who were not breast-fed. The influence of infection during pregnancy on the conceptus and some low-cost measures for reducing it are discussed. Measures for decreasing neonatal morbidity in rural and poor urban ureas are proposed.


Perinatal infections. General discussion II.


Experience sharing.

Experience sharing.


Increasing nurse power in health development. Seventeen months: hard problems and major decisions.


Perinatal infections: the obstetrician's viewpoint. The obstetrician's role is to recognize and treat maternal systemic infections which may spread transplacentally to the fetus, and to ensure that the lower genital tract is kept free from pathogenic organisms, particularly during the last trimester of pregnancy. In some cases the obstetrician can reduce the likelihood of premature rupture of the membranes by inserting a cervical suture. Where this has not been possible conservative management should be used to keep the fetus in utero before the 34th week and more active after this time. In trapartum infections can be reduced to a minimum by keeping the membranes intact during early labour, by the aggressive use of uterine stimulants to avoid prolonged labour, by exerting extreme care to avoid sepsis during pelvic examinations and internal monitoring, and by earlier use of Caesarean section.


Infections in neonatal units: prevention is better than cure.


Perinatal infections. Final general discussion.


Factors in the mother/infant dyad that influence the development of infections before and after birth. A number of maternal factors strongly influence the development and outcome of fetal infections. Severely undernourished mothers produce neonates with evidence of an immunoincompetence that persists into later childhood. Mothers who fast during pregnancy develop metabolic acidosis much more rapidly than non-pregnant women. The metabolic acidosis leads to high fetal and neonatal death rates from a variety of pre-existing disorders, including infections. Such metabolic acidosis also appears responsible for the excessive fetal and neonatal deaths associated with maternal urinary tract infections. Finally, coitus during pregnancy markedly increases both the frequency of bacterial infections of amniotic fluid and the mortality due to them. The effects are greatest at mid-pregnancy and gradually decrease to term.


The genesis of amniotic fluid infections. Amniotic fluid infections manifested by an inflammatory response in the extraplacental membranes and subchorionic plate of the placenta are a common phenomenon thought to be due in most cases to ascending bacterial infections via intact membranes. Fatal spread to the fetus is much less common and more likely to occur in underprivileged communities. The probable reasons are nutritional deprivation in the mother or both, leading to production of a liquor with diminished ability to suppress bacterial growth. Zinc is one component of the antibacterial system but liquor levels of zinc vary widely and inconsistently with antibacterial activity. Dietary supplementation with zinc did not improve antibacterial activity of liquors in a population with diminished liquor antibacterial activity and large number of fatal infections. Other factors in the genesis of amniotic fluid infections may be interference with normal defence mechanisms as a result of coitus in late pregnancy and vaginal infections with Trichomonas vaginalis. Socioeconomic factors may play a role apart from their association with maternal nutrition, through diminished hygiene associated with insufficient use of water and insufficient availability and use of medical facilities.


Consequences of amniotic fluid infections: early neonatal septicaemia. This study describes the results of examination of blood cultures from infants born in a community with a high prevalence of fatal amniotic fluid infection. The incidence of first-week neonatal septicaemia was 5.5 per 1000 births. Septicaemia was detected in 38% within 12 hours and 75.6% within 72 hours of birth. The aetiological pattern of the septicaemia was similar to that of fatal amniotic fluid infections. The increase in mortality from septicaemia occurred in infants born after 34 weeks of gestation. Nearly 80% of the infections apparently occurred through intact membranes. Respiratory distress with or without radiological evidence of pneumonia was the only manifestation of septicaemia in most infants under four days of age. Low Apgar scores and multiple apnoeic episodes were more common in infants with septicaemia than in those without septicaemia. Neonatal jaundice with serum bilirubin in excess of 11 mg/dl was more common in septicaemic infants and indicated poor prognosis. Meningitis associated with septicaemia occurred in 3.8% and in all these infants the diagnosis of septicaemia was delayed beyond 72 hours. The results suggest that early recognition and treatment of antenatal bacterial infections may prevent mortality and morbidity from complications of septicaemia such as neonatal apnoea, meningitis and bilirubin encephalopathy.


World Health Organization, Regional Office for Europe. Working group on changingpatterns in mental health care.


Use and abuse of food exchanges.

Use and abuse of food exchanges.


Drug abuse assessment guide.

Drug abuse assessment guide.


Diabetes class starts on Monday.

Diabetes class starts on Monday.


Bacteroides meningitis successfully treated with metronidazole. Bacteriodes meningitis without associated cerebral abscess occurred in an elderly man who had a long history of chronic otitis media. Anaerobic cultures of the cerebrospinal fluid revealed bacteroides organisms. Sensitivity testing showed them to be resistant to penicillin and chloramphenicol but sensitive to metronidazole. Appropriate therapy with this agent eradicated the causative organisms and produced rapid clinical improvement.


The condition of surgery: an analysis of the American College of Surgeons' and the American Surgical Association's report on the status of surgery. The supply of surgical services--a function of both the number of surgeons and the amount of surgery each performs--was extensively studied as a basis for new public policies in medical practice. The Report concludes that there is a surplus of physicians performing surgery and recommends restricting their number through more rigorous board certification and reducing the number of new entrants to specialized training. But the technological criteria advanced to assure "quality" are not based on adequate empirical  evidence; and control by surgeons over their own numbers is likely to have uneven--and unfavorable--consequences for the public. The causes of surplus surgical capacity must be explained, and impediments to self-correction through competition in the "medical market" addressed in future policy.


Bayes' theorem, the exercise ECG, and coronary artery disease.


Central nervous effects of a new tricyclic antidepressant (amitriptylinoxide). The central action of amitriptylinoxide was investigated in mice and rats using established models. The substance was found to possess antidepressant, drive-promoting properties which correspond to amitriptyline in their intensity or are superior even. In addition the pharmacodynamic spectrum of amitriptylinoxide displays a sedative component that is considered a desirable accompanying effect but is somewhat weaker than with amitriptyline. According to revealed differences in this work between the pharmacological activities of amitripytlinoxide and those of other tricyclic antidepressants, it became reasonable to undertake further studies to investigate its main and side effects.


A consideration of risk factors and development of chronic bronchitis in a five-year follow-up study of an industrial population. A five-year follow-up study in an industrial population showed that the prevalence and development of chest symptoms in men was related mainly to their smoking habits and, to a lesser degree, to age. Mean FEV1 values were related to age, and decrease in FEV1 was related to age and smoking habits. The levels of airborne dust and fluorides at the working places were related to the prevalence of chronic bronchitis (CB) symptoms, to the persistence of those symptoms during the five-year period, and to decrease of FEV1 values during that time. The decrease in FEV1 was especially noticeable among current smokers. The five-year incidence study showed that particular occupational factors do indeed have a real effect, but their meaning in the development of the CB syndrome is less marked than was expected from the prevalence rates.


Studies of factors regulating the ageing of human erythrocytes. II. Metabolic depletion of erythrocytes is not accompanied by a decrease of their sialic acid content during blood bank storage. Erythrocytes from human blood stored at 5 degrees C in anticoagulant-preservative solutions are considered, after a period from 21 to 24 days, unsuitable for transfusion. The nonviability of the cells appears due to metabolic impairment accompanied by a change of the biophysical properties of the cell but surprisingly not to a decrease of sialic acid of the membrane. The absence of proteolysis can be attributed to calcium chelation and to the stable levels of plasma protease inhibitors throughout the storage period. In fact, when erythrocytes are incubated for several days at 5 degrees C in protein-free media, release of sialopeptides from the membrane increases slowly and steadily, particularly if the medium is without glucose and adenine but contains divalent cations. Moreover, this phenomenon is strikingly amplified when incubation in protein-free media is carried out at 37 degrees C and once the ATP level has fallen below 5% of its initial value.


Congenital dislocation of the hip.

Congenital dislocation of the hip.


Epidemiology of cutaneous leishmaniasis in Afghanistan. Part 2. Anthroponotic cutaneous leishmaniasis.


Recommended practices for the prevention of mycotoxins in food, feed and their products.


Messenger RNA hybridized with the DNA isolated from hepatitis B Dane particles.


A new type of force-sensitive device using carbon fiber and its biomedical application.


Prevention and treatment of postoperative atelectasis in aged patient.


Electron microscopic study of IgG-Fc receptors on tumor cells of human gastric carcinoma.


Help liberate your own country from the terror of leprostigma. An appeal to readers.


Effect of catecholamine on the contractile responses of rabbit colon and duodenum to vagus nerve stimulation in vivo.


Leprostigma in hanseniasis.

Leprostigma in hanseniasis. Ignorance, fear and superstition surround the problems of hanseniasis. In almost all cultures the predominant attitude is emotion, disgust and rejection towards persons suffering from this disease. All efforts aimed at the control of hanseniasis are doomed to failure unless the significance of stigma and associated social and economic factors are given adequate consideration. A programme of destigmatization is outlined.


Diabetic status in leprosy.

Diabetic status in leprosy. The diabetic status of the local Jhansi patients (120 cases) was established before and after antileprosy treatment. Control studies were performed in normal healthy subjects (50 persons) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2%, while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6.4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus. Incidentally it was noted that 'diabetic status' was worse among males (82.3%) and with advancing age. Association and improvement of diabetic status with specific treatment would tentatively suggest that Mycobacterium leprae lesions are not confined to skin alone but somehow also related to carbohydrate metabolism. A careful management of the chemical and latent diabetes may help in clinical management of leprosy too.


Changes in somatomedin-like activity and concentrations of growth hormone and prolactin in the plasma of castrated growing lambs. Somatomedin-like activity was measured in the plasma of growing lambs using the porcine costal cartilage disk assay. Plasma concentrations were found to be high initially at 2 days of age (mean potency 1.02 plus or minus 0.13 (SEM) units/ml, n = 4) declined significantly by 8 days of age (mean potency 0.65 plus or minus 0.04 units/ml, n = 5, P less than 0.01, analysis of variance). Thereafter somatomedin-like activity declined slowly to reach its lowest concentration at 146 days of age (mean potency 0.61 plus or minus 0.04 units/ml, n = 5) then it rose slowly until 288 days of age (mean potency 0.61 +/- 0.04 units/ml, n = 5. These changes in somatomedin-like activity were accompanied by high initial plasma concentrations of growth hormone (24.8 plus or minus 4.8 ng/ml, n = 5) which declined under 188 days of age (2.8 plus or minus 0.04 ng/ml, n- 5) and then rose slightly until 288 days of age (13.8 plus or minus 9 ng/ml, n=5). Plasma prolactin concentrations showed a different pattern being low initially (47.8 plus or minus 8.7 ng/ml, n = 5) rising until 146 days of age (203 plus or minus 16 ng/ml, n = 5) and then declining to low value for the rest of the experiment. The relationships between these factors is not clear but somatomedin-like activity shows a pattern in the lamb which is highest when growth is faster (i.e. in the young lamb).


The influence of early nutrition on growth and the circulating levels of immunoreactive somatomedin A. The effect of nutrition during early development on growth and serum immunoreactive somatomedin A was examined in rats by rearing in small or large liters. At weaning, body weight, brain weight, liver weight and DNA content was significantly reduced in rats whose nutrition was restricted by rearing in large litters. Brain DNA content was significantly altered. Serum somatomedin A was significantly reduced in the growth-retarded rats as compared to those whose growth was enhanced by rearing in small litters. Similarly, maternal serum somatomedin A was significantly reduced in rats nursing large litters.


Placental diffusing capacity and its relation to fetal growth. The placental diffusing capacity for carbon monoxide was measured in unanaesthetized monkeys (M. Mulatta). Maternal and fetal blood was sampled from chronically placed catheters while the mother breathed 50 or 100 parts per million of CO. Diffusing was calculated from the amount of CO taken up by the fetus divided by the partial pressure difference across the placenta, it averaged 0.646 plus or minus 0.062 (SEM) ml x min(-1) x torr(-1) x kg(-1) of fetal weight. The significance of this index of respiratory gas exchange in the monkey placenta is discussed with respect to previous measurements in other species and with respect to fetal growth.


Progestagen metabolites in fetal sheep plasma: the effect of fetal nephrectomy. Fetal sheep (100-115 days gestation) were surgically implanted with femoral arterial and venous cannulae and then either sham-operated (control) or bilaterally nephrectomized. Following a 5-day recovery period, fetal blood samples (10 ml/48 h) were taken and the steroid sulphate fraction analysed as trimethylsilyl esters by gas-liquid chromatography (g. l.c.). Three progestagen metabolites were repeatedly detected in plasma samples from control and nephrectomized fetuses and identified by g.l.c.-mass-spectrometric techniques as 5 beta-pregnane-3 beta,20 beta-diol, 5 beta-pregnane-3 beta,20 alpha-diol and 5 beta-pregnane-3 alpha,20 alpha-diol. In three control fetuses the plasma concentration of both 5 beta-pregnane-3 beta,20 beta-diol and -20 alpha-diol showed a steady increase from about 0.5 micrograms/ml at 105 days to about 1.5 and 2-2.5 micrograms/ml, respectively, at 143 days gestation. A study in one fetus indicated that the values then fell precipitously by term (147 days) as plasma cortisol concentrations rose. In contrast, whilst no consistent patterns were seen in their concentration in five nephrectomized fetuses the levels were 2-10 times higher than the control values (0.5-10 micrograms/ml) at all stages. The plasma concentration of 5 beta-pregnane-3 alpha,20 alpha-diol was less perturbed by nephrectomy and only showed a slight increase over control values (0.2-0.5 micrograms/ml). Three sham-operated fetuses which aborted following infection also showed increased plasma concentrations of 5 beta-pregnane-3 beta,20 beta-diol and -20 alpha-diol, similar to the nephrectomized fetuses. It is postulated that high levels of circulating progesterone metabolites may reflect induced increases in adrenal endocrine activity culminating in premature activation of those changes in adrenal function which trigger parturition.


Chemical injury of the spinal cord of the rabbit after intracisternal injection of gentamicin. A single intracisternal injection of 0.4 ml of 1.25 and 2.5 percent gentamicin sulfate with preservative to healthy adult rabbits caused acute respiratory paralysis and severe seizure activity initially and paralysis of the limbs subsequently. In the white matter of the upper cervical spinal cord, multiple, minute, disseminated, spongy lesions were observed. They consisted of lysis of axis cylinders, edematous dilatation of myelin sheaths, and loss of astroglia and interfascicular oligodendroglia. Axonal end-bulbs formed at the periphery of the lesions. Clinically and morphologically, 0.025 and 0.25 percent gentamicin sulfate solution did not produce myelopathy. The spinal lesions were distributed differently from those of other chemical myelopathies in that they developed in the deeper white matter with sparing of marginal myelinated fibers. Circumscribed high concentrations and gentamicin, and vulnerability of myelinated axis cylinders and interfascicular oligondendroglia to gentamicin may be the main factors causing these lesions. When gentamicin sulfate without preservative was injected, neutrophil leukocyte infiltration occurred actively in the spongy lesions. In the cervical spinal ganglia some nerve cells underwent cytoplasmic vacuolation. In control animals a single intracisternal injection of saline or preservative did not result in the production of these lesions.


Glycogen accumulation in the nerves and kidney of chronically diabetic rats. A quantitative electron microscopic study.


Cytologic observations on axotomized feline Betz cells. 1. Qualitative electron microscopic findings. Adult cats survived left lateral funiculotomy 1 to 153 days. The pericruciate cortex was studied electron microscopically in these as well as sham-operated and unoperated animals. Ten days after surgery Betz cells of the right pericruciate cortex displayed disaggregation of cytoplasmic ribosomes; random dispersal and degranulation of the normally compact arrays of cisterns of rough ER; in some cells perinuclear and peripheral disposition of remaining Nissl bodies; retispersion of the Golgi apparatus; and, uncommonly, neurofilamentous hyperplasia. Fourteen days postoperatively cytoplasmic ribosomes were largely regrouped in rosette arrangements and Golgi membranes were evenly distributed in the cytoplasm. Further reversion of the ER toward a normal appearance occurred 28 days postoperatively but substantial perikaryal atrophy had supervened in many neurons by 49-153 days after surgery. Evidence of nerve cell death was not found. Concentric membranous arrays derived from ER and associated with autophagic bodies and mitochondria were identified in dendrites of normals and cats that had been operated upon, perhaps more frequently contralateral to the spinal operation. Electron-dense and electron-lucent degenerative changes in dendrites also occurred, especially early after operation. Degenerating myelin sheaths were detected in the pericruciate cortex of animals that had been operated upon and sometimes were captured in the process of phagocytosis by oligodendrocytes as well as astrocytes and microglia. The long-term persistence of axotomized Betz cells, albeit in an atrophic state, and the reversibility of some of the cytologic responses to axon injury suggest that these neurons may retain a capacity for axon regeneration that could be mobilized, as by pharmacologic means.


A pigmented choroid plexus carcinoma: histochemical and ultrastructural studies. A large tumor of the left lateral ventricle in a 3 1/2 year old male was diagnostic of malignant choroid plexus papilloma (choroid plexus carcinoma) as observed histologically. Focal neoplastic epithelial cells contained yellow-brown pigment which was not entirely compatible with melanin by histochemical techniques. Ultrastructurally, the tumor had definite evidence of choroid plexus origin. The neoplastic cells contained electron-dense and lamellar bodies, as well as structures of intermediate type. Premelanosomes were not observed. Thus there was no evidence for neural crest melanin. It is suggested that the pigment is probably lipofuscin and melanin derived from lipofuscin by "melanization" through pseudoperoxidation.


Studies on the isolation and characterization of theilerial antigens: particularly on the applicability to passive hemagglutination test.


Antiviral compounds. XIII. Synthesis and anti-influenza virus activity of N-(1-adamantyl)amidinohydrazones.


Amino acid compositions of the components from 6N HCl-solubilized collagen.


Immunological aspects of early development.


Clinical issues and concerns: in vitro fertilization techniques and status in humans.


Mechanisms of conception: the maturation and interaction of mammalian gametes.


Polymyositis and related disorders.

Polymyositis and related disorders.


Spinal muscular atrophy.

Spinal muscular atrophy.


Primary care in Puerto Rico.

Primary care in Puerto Rico.


Hypertension and orthostatic hypotension in applicants for flying training and aircrew. Aeromedical investigation, clinical assessment, and evaluation for flying duties.


Incidence of spontaneous pneumothorax in apparently healthy aircrew.


Evaluation and information systems.

Evaluation and information systems.


Trimethoprim-sulphamethoxazole treatment in premature infants with salmonella infection.


Splenic functions in non-negro patients with sickle-cell anemia and sickle-cell beta thalassemia.


Use of information systems in the administration and evaluation of drug treatment programs.


An information system for treatment evaluation in substance abuse.


The importance and control of diarrhoea in a rural community.


A preliminary assessment of drug abuse treatment in Italy.


Malignant histiocytosis associated with malabsorption.


Severe hyperglycemia and intracranial hemorrhage in a premature infant with fetal malnutrition and pulmonary infection.


MIS-based client outcome evaluation: a multi-measure approach.


Implications for evaluation of drug dependency treatment based on data provided by a management information system.


Additional pathologies in tetralogy of Fallot.


Program-level evaluation using management information. This paper has summarized the development of a drug abuse treatment program MIS, and has shown that one can initially start with a manual system, use it to advantage, and then move into computer programming. In larger programs, it will most likely be necessary to use the computerized system. However, the author has found that implementation costs have not been great, and the system has certainly been worthwhile in light of the dimensions that have been added to the program. The computer MIS that has been developed is completely modularized from the perspective that either one or all modules may be used. Small programs that need only demographic data can use selected aspects of the system without having to pay for or use the rest. Those who only need counseling information can use just that, and those who only wish to have economic activity can also be selective. The strength of this MIS is based upon the fact that it is completely flexible; it is cost effective, and can be used by programs of any size. Finally, use of a sophisticated MIS in drug treatment programs adds a professional facet to service delivery which has long been missing in the drug abuse field.


The effect of mitochondrial dysfunction on glucose metabolism during shock. Hepatic glycogen content, blood glucose and lactate concentrations, and hepatic mitochondrial energy-linked functions were measured in rats in late hemorrhagic shock. As judged by correlation coefficients, the following significant relationships were noted: (formula: see text). Glycogen depletion, hypoglycemia, and lactic acidemia occurred frequently. However, alone or in combination, these variables did not relate significantly to need for or amount of shed blood uptake prior to sacrifice. Neither hepatic glycogen depletion nor uncoupled hepatic mitochondrial oxidative phosphorylation alone accounted for hypoglycemia. The genesis of hypoglycemia was determined by the occurrence of both these events in either sequence. When hepatic mitochondrial oxidative phosphorylation became uncoupled, the blood glucose concentration and hepatic glycogen content were linearly related (r = 0.94). This effect probably results from impaired gluconeogenesis due to mitochondrial dysfunction.


Regional gastric blood flow in cynomolgus monkeys with hemorrhagic shock and resuscitation. Five anesthetized cynomolgus monkeys were subjected to hemorrhagic shock (42 +/- 3 mm Hg) for four hours and then resuscitated with shed blood and intravenous fluids to restore mean arterial pressure and arterial pH to control levels. Regional gastric blood flow was measured by radioactive microspheres. Responses were similar in all regions, except mucosal blood flow increased significantly (from 20.1 +/- 5.1 to 42.1 +/- 7.6 ml/min 100 gm of tissue) in response to resuscitation in the antrum but not in the fundus or corpus. This difference in response may explain the occurrence of stress ulcers in the proximal stomach with sparing of the antrum.


Ultrasonography in renal diseases.

Ultrasonography in renal diseases.


Zymosan-induced resistance to endotoxin and hemorrhagic shock. Improved surgical techniques and judicial use of available antibiotics have reduced the number of postoperative complications over the past decade. However, septic and hemorrhagic shock occur all too frequently, and each carries with it an appreciable morbidity and mortality. Endotoxins and hemorrhage are both known to suppress the phagocytic activity of the reticuloendothelial system (RES). On the other hand, zymosan, a yeast (Saccharomyces cerevisiae) cell wall preparation administered intravenously, results in temporary RES hyperplasia and increased phagocytic activity. Dogs were pretreated with zymosan to determine the degree of RES stimulation and protection against endotoxin and hemorrhagic shock attainable. Twenty-five dogs received intravenous zymosan (10 mg/kg) on days 1, 2, and 3. Another 24 dogs served as controls. On day four, one-half the animals in each group received E coli endotoxin (1.5 mg/kg) intravenously. The other animals underwent two hours of hemorrhagic shock at a mean blood pressure of 40 mm Hg. Seventy-two hour survival was as follows: Endotoxin treated, 66.7% (8/12); endotoxin control, 27% (3/11); hemorrhagic treated, 53.3% (8/15); and hemorrhagic control, 28.6% (4/14). Hemodynamic, metabolic, and lysosomal enzyme parameters were evaluated. No zymosan toxicity was observed. These findings suggest that an RES stimulant such as zymosan could be incorporated as preoperative adjunctive therapy to induce resistance to these shock syndromes in the elective surgical patient.


The effect of indomethacin on cardiovascular and lysosomal mechanisms during experimental myocardial ischemia. The present study evaluated the effects of indomethacin (INDO) on cardiovascular and lysosomal mechanisms during experimental myocardial ischemia (MI). INDO (5 mg/kg) was infused IV prior to MI, and the results were compared to vehicle-treated and sham-operated dogs. INDO induced a slight hypertension after MI. Additionally, INDO attenuated the decline in coronary blood flow in the non-ischemic myocardium after MI. Myocardial lysosomes (biopsied three hours post-MI) were more labile in ischemic than in nonischemic tissue, and INDO had a stabilizing effect on lysosomes from ischemic tissue. Plasma activity of cathepsin was increased following MI, and INDO attenuated this increase. In the myocardium (biopsies three hours post-MI) prostaglandin A + E levels were suppressed 60% in both ischemic and nonischemic tissue with INDO treatment; prostaglandin F2 alpha levels were lower with INDO treatment but not significantly so. These results suggest that INDO has a stabilizing effect on lysosomes in vivo, possibly involving an endogenous prostaglandin mechanism, and this protective effect may attenuate lysosomal damage to the cardiovascular system during MI.


Glucagon treatment of hemorrhagic shock: improved survival and metabolic parameters in a murine shock model. One hundred-twenty Sprague-Dawley rats were shocked at 60 torr for 60 minutes and at the end of this period shed blood was reinfused. The animals were divided into three groups at random. These groups were either treated by N saline or glucose in N saline or glucagon in N saline. Glucagon treatment resulted in increased liver and muscle glucose-glycogen stores in the late period following shock. This was associated with a decrease in liver pyruvate and lactate and improved survival. It appears that glucagon more favorably affects the response to shock in this model than does treatment with glucose or saline.


Protection against superior mesenteric artery occlusion shock by soluble and nonsoluble reticuloendothelial stimulants.


Alterations in venous compliance in hemorrhagic shock. Nine dogs and one primate were placed on total cardiopulmonary bypass and subjected to a simulated hemorrhagic shock procedure. Venous compliance was determined by occluding the venous outflow catheters; venous flow and pressure drop were used to calculate resistance. Individual measurements were made for the superior (SVC) and inferior vena caval (IVC) beds. During hypotension, compliance increased equally in the SVC and IVC; following reinfusion, IVC compliance was consistently lower than SVC compliance. Resistance of the sVC system increased slightly more rapidly during early hypotension than did that of the IVC, but SVC resistance then decreased and remained significantly below that of the IVC system throughout the posthypotension period. These results are interpreted as indicating a different response of the two vascular beds, particularly an increase in IVC arteriolar resistance with a decrease in venous tone. To the extent that the splanchnic bed contributes to the IVC system changes, they are contrary to the concept of a maintained venous tone and decreased arteriolar tone after hemorrhagic shock.


The effect of arachidonic acid on the response of the isolated liver to hypoxia. Arachidonic acid, the precursor molecule of the bisenoic series of prostaglandins, was investigated for its ability to modify the response of isolated perfused livers to hypoxia. Rabbit livers were perfused at a constant rate of flow with Krebs-Henseleit bicarbonate buffer for two hours following the initiation of severely hypoxic conditions. This procedure resulted in significant increases in the wet weight of the liver, and also resulted in the release of intracellular enzymes into the perfusion medium. These changes were significantly attenuated in hypoxic livers receiving arachidonic acid during the two-hour perfusion period. Results of this study suggest that arachidonic acid may be of value in its ability to maintain cellular integrity during periods of cellular hypoxia.


Studies of the ischemic pancreas in shock. Exocrine pancreatic tissue from 65 male Sprague-Dawley rats was studied by light and electron microscopy to determine if acute lethal and sublethal alterations seen in the human exocrine pancreas following shock could be duplicated in an animal model. Two models were used: one in which 50% of the blood was withdrawn via cardiac puncture with no reinfusion and another in which the animal was subjected to a hypovolemic episode (40 mm Hg) for 60 minutes, with reinfusion of the blood. Animals were killed at various intervals, and pancreatic tissue was sampled for morphological study. No differences were seen between experimental and control animals by light microscopy. The main subcellular alteration seen using these models was the formation of numerous autophagic vacuoles. From these studies it appears that the alterations seen in the human pancreas in shock can be duplicated in the rat and that a shock model that involves removal of more than 50% of the animal's blood volume is necessary to cause irreversible cell damage to the exocrine pancreas.


Hypoxia, hyperammonemia, and cerebrospinal fluid metabolites. During hemorrhagic shock, increased uptake of NH3 from the gut with inadequate compensation by the liver results in hyperammonemia. The effect on brain metabolism of acute hyperammonemia alone, as compared with normocapnic hypoxia, was investigated in 11 pentobarbital anesthetized (30 mg/kg) dogs. These animals were paralyzed (pancuronium bromide) and artificially ventilated to maintain the end-tidal fraction of FETCO2) CO2 constant. Arterial blood and cerebrospinal fluid (CSF) samples were obtained following control, 30-minute hypoxia, 60-minute NH3 infusion, and 30-minute hypoxia combined with NH3 infusion. These were analyzed for PaO2, PCO2, pH, and NH3. CSF samples were further analyzed for glutamine, urea, lactate, pyruvate, and citrate. There were no significant changes in urea or citrate. Glutamine, lactate, and the lactate/pyruvate ratio were significantly elevated by hypoxia and by NH3 infusion. (formula: see text). Thus, an acute NH3 load is capable of disrupting aerobic glycolytic metabolism. Hence, hyperammonemia may affect brain function during shock.


Amelioration of splanchnic artery occlusion (SAO) shock by cysteine.


The support of trauma research.

The support of trauma research.


Effect of moderate hemorrhagic hypotension on cerebral metabolism during ventriculocisternal perfusion in the conscious dog. Early changes in cerebral metabolism during hemorrhagic hypotension in conscious dogs have been studied with a chronic ventriculocisternal perfusion system. The mean arterial blood pressure was held above the lower limit of the cerebral autoregulatory curve. There was a rise of free fatty acids (FFA) in cerebrospinal fluid at 30 minutes after the onset of hemorrhage. The cerebral arteriovenous difference of oxygen (AVDO2), AVD-glucose, and AVD-pH increased significantly after 60 minutes of hemorrhage, while AVD-TCO2 (tissue culture oxygen) rose only slightly. These changes may reflect some of the metabolic alterations that occur in moderate hypotension.


Evidence for pathophysiologic arteriovenous shunting in the pathogenesis of acute gastric mucosal ulceration. The triad of gastric mucosal ischemia and lumenal acid and bile is known to be ulcerogenic. However, the explanation for progressive mucosal injury after resuscitation from hemorrhagic shock is not known, because ischemia does not persist. To test the hypothesis that persistent pathophysiologic arteriovenous shunting is the cause of progressive mucosal injury after shock, we studied in vivo canine gastric mucosal oxygenation and transmembrane potential difference during and after one hour of hemorrhagic shock with and without topical acid (160 mM HCl) and taurocholate (1 mM) in the mucosal bathing solution. Although systemic blood pressure and total gastric blood flow returned to normal after shock in all groups, only the group with topical acid and taurocholate developed mucosal erosions and had persistent hypoxia and inhibition of potential difference in surface epithelial cells. We conclude that pathophysiologic arteriovenous shunting persists in the superficial part of the gastric mucosa after shock. It is tempting to speculate that shunting may replace ischemia in the ulcerogenic triad during the postresuscitation phase of injury.


Influence of hyperglycemia on survival after hemorrhagic shock. Terms such as "insulin resistance" and "glucose intolerance" applied to shock-induced hyperglycemia suggest that this state may prejudice survival. However, our data indicate that posthemorrhage hyperglycemia improves short-term survival. Rabbits, either fed until the experiment or fasted for 24 hours, were shocked by rapid removal of 25% of their blood volume (BV) measured by 131IHSA. During the next 60 minutes, blood pressure (BP) was recorded, and the following variables were measured every 10 minutes: plasma volume (PV); arterial and venous plasma osmolality (PO), glucose, lactate, Na, K and hematocrit. Other fasted animals studied similarly received short intravenous pulses of hypertonic xylose after bleeding. The PO of fed animals, who all survived for 60 minutes rose to an extent accounted for by rises in glucose and lactate. A significant PV fluid gain was maintained for 60 minutes. The fasted animals, 42% of whom died before 60 minutes, had a flat glucose curve with a correspondingly small rise in PO. The PV fluid balance, after an initial small gain, became negative. Although a lower blood pressure in fasted rabbits was probably due to lack of PV refill, death resulted from hyperkalemia. Poor tolerance of fasted animals to shock is not attributable only to less glucose for energy metabolism, because when they received xylose, homeostatic features of fed animals were restored. The data suggest that, immediately after hemorrhage, glucose acts as a nonpermeant solute drawing fluid into the circulation. This study also shows that control of the nutritional status of animals used for shock models is important.


Ultrastructural study on kidney cell injury following various types of shock in 26 immediate autopsy patients. In acute renal failure in man following shock and trauma, an amazing discrepancy was found between the complete breakdown of renal function and the very modest histological and ultrastructural changes in "immediate autopsy" patients, even in those who sustained septic shock. Although, from this limited number of studies no satisfactory interpretation of the pathogenesis of acute renal failure can be deduced from the structural changes found, the findings do indicate that hypoxia plays a key role in aggravating the structural changes that induce permanent cell damage in man following shock of various etiologies including septic shock.


Open-field performance of rats after endotoxin treatment.


Some experimental effects with trazodone.


Changes in the measurement of postural sway resulting from repeated testing.


Effects of hydration and physical therapy on tracheal transport velocity. A new tracer method for quantitative measurement of tracheal transport velocity (mm per min) in dogs has been described. Using the same technique, the effects of dehydration, rehydration, postural drainage, and chest percussion on tracheal transport velocity were studied. Mean tracheal transport velocity decreased significantly (14.1 +/- 1.4) after dehydration (P less than 0.05) and reverted to normal (19.0 +/- 1.3) with rehydration in 10 dogs. After postural drainage in 7 dogs, mean tracheal transport velocity increased 39.7 +/- 1.78 (SE) per cent (P less than 0.01). After chest percussion in 6 dogs, mean tracheal transport velocity increased 50.9 +/- 1.22 (SE) per cent. With combined postural drainage and chest percussion, mean tracheal transport velocity increased 50.0 +/- 0.32 (SE) per cent. Although maximal improvement occurred after the combined therapy, the changes were not significantly different from those observed with each therapy alone. These therapeutic measures have been used empirically in the past. The present study gives some objective evidence for their beneficial effects in anesthetized dogs.


Isolation and properties of type II alveolar cells from rat lung. Type II alveolar cells can be isolated and partially purified from adult rat lung by a series of steps that includes enzymatic digestion of the lung with trypsin and separation of cells on a discontinuous albumin density gradient. The yield of the isolated type II cells depends on the supplier and the housing of the rats used to prepare the cells. With specific pathogen-free rats housed in a laminar flow hood, the yield was 20.3 x 10(6) cells per rat, of which 50 per cent were type II cells. With rats from 2 other suppliers and no special housing, the yields were 8.8 and 8.3 x 10(6) cells per rat, of which 67 and 65 per cent were type II cells. The ultrastructural appearance of the isolated cells was similar to that of cells from intact lung, except for some dilatation of the endoplasmic reticulum and the perinuclear space. Most cells (92 +/- 5 per cent) excluded the vital dye, trypan blue. The cells consumed O2 at the rate of 76 +/- 12 nmole per 10(6) cells per hour and released only 5.7 +/- 2.0 per cent of their lactate dehydrogenase, a cytoplasmic enzyme, into the medium after 1 hour of incubation. The isolated type II cells contained disaturated phosphatidylcholine, a major component of purified surface-active material. The cells, however, had a low glucose utilization compared to their O2 consumption, which may indicate an abnormality in the metabolism of glucose. This population of cells could be further purified to 89 per cent type II cells by unit gravity velocity sedimentation.


The failure of aerosolized superoxide dismutase to modify pulmonary oxygen toxicity. Superoxide (O2-.) is a highly toxic free radical that may be an important component of pulmonary O2 toxicity. The primary defense against this free radical is superoxide dismutase. Rats were exposed to aerosolized superoxide dismutase, and it failed to modify either the time course or the cumulative toxicity of 100 per cent O2. Because the aerosolized enzyme can be expected to be delivered only to the extracellular space of the lung, it is suggested that the primary site of production and of damage due to O2-induced free radicals must be within the intracellular space.


Lymphomatoid granulomatosis: association with retroperitoneal fibrosis and evidence of impaired cell-mediated immunity. Lymphomatoid granulomatosis is a non-neoplastic lymphoreticular disorder that usually presents as primary lung disease. A case of lymphomatoid granulomatosis associated with retroperitoneal fibrosis is reported. The retroperitoneal fibrous tissue contained the same variegated lymphoreticular infiltrate that formed the lung tumor, suggesting that the disease may have begun in the retroperitoneum. An extensive immunologic evaluation of the patient revealed impaired cell-mediated immunity.


Primary pulmonary sporotrichosis.

Primary pulmonary sporotrichosis. A 34-year-old alcoholic and drug addict developed cavitary pulmonary sporotrichosis that progressed slowly during 6 years. Pulmonary resection and pre- and postoperative therapy with amphotericin B were associated with prompt clinical improvement with no evidence of relapse during a 2-year follow-up. Histologic examination of lung revealed granulomatous inflammation with organisms consistent with Sporothrix schenckii, and interstitial talc (magnesium silicate) granulomas. The latter finding was consistent with the history of intravenous drug abuse. Although the presence of silicates in lung enhances the pathogenicity of some microorganisms, the relation of these findings to the pathogenesis of sporotrichosis in our patient is unclear.


Endobronchial foreign body demonstrated by xerotomography. A case of pneumonia secondary to aspirated foreign body is presented. Xerotomography was useful in detecting abnormalities of the tracheobronchial tree and in demonstrating endobronchial foreign bodies.


An urban epidemic of North American blastomycosis. Five culturally proved cases of blastomycosis occurred in a 9-month period during 1974 and 1975 in a western suburb of Chicago. All patients lived within a 1-mile radius of the center of Westmont, Ill. (population, 12,000). Three of these patients lived in adjacent buildings in the same apartment complex. None of the patients had significant outdoor exposure. Dust from a nearby construction site was postulated as a possible common source, although soil cultures from the area were negative. This is the third chronologic epidemic of the blastomycosis; a fourth one has been reported. It is the only outbreak to occur in a major metropolitan area.


Effects of beclomethasone dipropionate on tracheal mucous velocity. Beclomethasone dipropionate (200 micrograms, administered by inhalation to conscious sheep, does not affect tracheal mucous velocity during a 60-min period.


In search of the pump handle, 1977.

In search of the pump handle, 1977.


Respiratory abnormalities among grain handlers: a clinical, physiologic, and immunologic study. A survey of 300 grain elevator workers revealed that 77 per cent complained of eye symptoms; 64 per cent, of nasal symptoms; and 88 per cent, of one or more respiratory symptoms on exposure to airborne grain dust. Symptoms on exposure were independent of age and length of employment. Cough and wheezing on exposure were more common among smokers than nonsmokers (P less than 0.025). Nineteen per cent of the workers had had episodes of grain fever. The prevalence of chronic bronchitis was 37 per cent (42 per cent of smokers and 30 per cent of nonsmokers). Wheezes on auscultation were found in 23 per cent. Measurements of lung ventilatory function, as well as diffusing capacity, correlated significantly with age and smoking habits, but not with length of employment. Thirty-seven per cent of the workers had an abnormal mean forced expiratory flow during the middle half of the forced vital capacity (47 per cent of smokers and 13 per cent of nonsmokers), and 34 per cent had an abnormal maximal expiratory flow after exhalation of 50 per cent of the forced vital capacity (40 per cent of smokers and 13 per cent of nonsmokers), whereas only 13 per cent had an abnormal ratio of 1-sec forced expiratory volume to forced vital capacity. There was no correlation between precipitins to fungi, bacteria, grain, or grain dust antigens and acute or chronic respiratory symptoms, lung function, or grain fever. There was, however, a significant correlation between cutaneous reactivity to grain dust and wheezing on exposure (P less than 0.02). Abnormal flows at low lung volumes were more common among cutaneous reactors to common allergens. We concluded that exposure to airborne grain dust can cause acute inflammatory reaction to the exposed mucosa, and it is highly probable that grain dust contributes and, in some cases, causes chronic airway disease.


Sequential immunologic stimuli to the respiratory tract: a paradox in the degree of potentiation of airway responses depending on the sequence of reverse passive and active immunologic stimulation. Immunologic stimuli to the airway of rhesus monkeys were given by aerosol challenge with ascaris antigen or anti-IgE. Both of these stimuli produce immediate-type airway responses. When 2 sequential aerosol challenges were given during the same experiment, the response following the second stimulus was always less than or equal to the first response following any combination of stimuli except the anti-IgE-ascaris sequence. The second response following the latter challenge was always greater than or equal to the first response. The possibility that this exception was the result of anti-IgE priming mediator releasing cells for antigen was not supported by in vitro experiments. It is suggested that the results obtained with the anti-IgE-ascaris sequence may relate to the presence of intralumenal mast cells in the bronchi and the molecular weights of the 2 immunologic stimuli.


Airway response to carbachol in normal and asthmatic subjects: distinction between bronchial sensitivity and reactivity. By constructing cumulative dose-response curves to inhaled carbachol in 12 normal and 17 asthmatic subjects with comparable baseline specific airway conductance, we have shown that there were wide variations among subjects in the dose of carbachol needed to cause a 25 per cent decrease in specific airway conductance (bronchial sensitivity) and in the slopes of the curves (bronchial reactivity). Furthermore, there was no significant correlation between these 2 characteristics of the bronchial response to carbachol. The mean dose-response curves of the asthmatic and the normal subjects were widely divergent, indicating that the asthmatic subjects differed from normal subjects more in terms of bronchial reactivity than in bronchial sensitivity. This suggests that different mechanisms determine the sensitivity and reactivity of the bronchial tree, and that hyper-reactivity is the main feature of the asthmatic response. Both should be assessed when the bronchial response to bronchoconstrictor agents is measured.


Theophylline bioavailability: a comparison of the oral absorption of a theophylline elixir and two combination theophylline tablets to intravenous aminophylline. The bioavailability of theophylline from single doses of an elixir (Elixophyllin) and two different tablet formulations, as compared to intravenous aminophylline, was studied with a crossover design in 12 normal volunteers. Both tablet formulations (Marax and Tedral) contain ephedrine. Marax contains hydroxyzine hydrochloride, and Tedral contains phenobarbital. The absorption of theophylline was most rapid from the elixir, whereas that from Marax was faster than that from Tedral. The peak concentrations of theophylline after administration of the 3 oral dosage forms were in the order, elixir greater than Marax greater than Tedral, however, the time to achieve peak concentration was highly variable and did not differ significantly among the 3 products. On the basis of area under the serum concentration-time curves, the absorption of theophylline from the elixir and from Marax was essentially complete. The area under the serum concentration curve after administration of Tedral was significantly less than that after intravenous aminophylline, elixir, and Marax; however, when the individual areas under the concentration curves were adjusted for intrasubject variation in elimination rate constant, the mean area under the concentration curve after Tedral no longer differed significantly from those of the intravenous and other two oral products. A large degree of intersubject variation in the oral absorption of theophylline was observe din this study. Therefore, in addition to the well-documented, large individual variation in the serum clearance of theophylline, intersubject differences in the absorption of the drug is another factor that complicates proper adjustment of the dose in oral theophylline therapy.


An animal model of cigarette smoking in beagle dogs: correlative evaluation of effects on pulmonary function, defense, and morphology. Using beagle dogs, we have developed an animal model for the evaluation of the effect of chronic cigarette smoking on pulmonary defense and function and on lung structure. The smoking apparatus developed allows the dog actively to inhale properly diluted (1:4) smoke directly from the cigarette through a mouthpipe. In this model, 6-month and 1-year periods of mild to moderate smoking caused impairment of tracheal mucociliary transport and bacteriosuppressive activity of alveolar macrophages, with little change in pulmonary function. Morphologically, subtle, but significant, lesions were noted in the central airways and bronchiolar walls, consisting of tracheal epithelial basal cell hyperplasia, proliferation of goblet cells in central airways, and peribronchiolar infiltration by inflammatory cells. Morphometry of bronchiolar size distribution, volume proportion of parenchymal structure, and alveolar surface area, however, failed to show significant differences between the groups.


A comparative study of the mechanical properties in aging alveolar wall. Alveolar wall from the lung of aging humans shows a progressive decrease in maximal extensibility, which should follow an increase in resting tissue length rather than a reduction in maximal length. An increase in resting tissue length is compatible with the change in lung volumes and reduction in elastic recoil that occurs with time. A model of the lung was used to compare the effects of a change in resting tissue length in diminishing elastic recoil with that of a reduction in the volume density of the elastic elements (emphysema). Such differentiation is important in selecting an animal that may model the aging or emphysematous lung. In the rat, rabbit, and horse, alveolar walls show no decrease in maximal extensibility with age. In the male monkey (M. nemestrina and M. mulatta) between birth and 2.4 years there is a decrease in maximal extensibility that lacks significance for the limited age span examined. On the other hand, the energy loss in length-tension cycling (hysteresis) of alveolar wall increases in aging humans, diminishes in rats and rabbits, and shows little change in horses and monkeys. The breaking force of alveolar wall increases with age in rats and rabbits but does not change significantly in the other species. Of these species, the monkey promises a better model of the age-related changes in maximal extensibility of alveolar wall. A measure of maximal extensibility can distinguish the effects of dilatation of air spaces from those of destruction of alveolar wall in causing loss of lung elastic recoil.


Pulmonary hyalinizing granuloma.

Pulmonary hyalinizing granuloma. Twenty patients with pulmonary nodules consisting of concentric hyaline lamellae, usually accompanied by perivascular collections of plasma cells and lymphocytes, were studied. In most instances, the lesions were multiple, bilateral, and mildly symptomatic. Many of these nodules showed all of the staining characteristics of amyloid, but others had an atypical birefringence pattern. No infectious agents were identified, and no consistent pattern of dysproteinemia was observed. Two of the patients had prior histories of tuberculosis. In other cases, the nodules were of unknown origin and pathogenesis. Four cases were complicated by sclerosing mediastinitis, and one, by retroperitoneal fibrosis and amyloidosis. Our current working hypothesis is that these lesions represent an exaggerated and, possibly, continuing immune response, perhaps to one of a number of agents.


Rat liver isoenzymes in acute and chronic thioacetamide poisoning.


Relation of structure to function in arterial walls.


Lipoproteins in atherogenesis.

Lipoproteins in atherogenesis.


Lipoprotein lipase and hypertriglyceridemias.


Genetic hyperlipidemia and atherosclerosis.


Evidence for regression of advanced atherosclerotic plaques. The purpose of this presentation is to summarize briefly the evidence, much of it recent and direct, that the most prominent lesion components of the advanced atherosclerotic plaques in experimental animals, namely the necrotic center and the intracellular lipid, can undergo substantial regression. Some of the data will be reviewed indicating that this improvement of lesions in size, consistency and safety is due to a combination of remodeling, regression and healing. The recent evidence will be included indicating that human lesions can also respond favorably to the same rigorous serum cholesterol lowering regimens that lead to improvement of the advanced monkey and swine plaques.


The emerging cellular pathobiology of atherosclerosis. The purpose of this paper is to present a brief coordinated overview of the recent results of research at the artery cell level which appear to have the greatest impact on the rapidly improving understanding of the pathogenesis of atherosclerosis in humans. The majority of these studies have employed in vitro methods and utilized the tools of modern cellular and molecular biology. These include microdissection; cell separation; tissue or cell culture; enzyme, lipid and protein chemistry as well as immunochemistry, ultrastructural visualization, cell organelle and membrane fractionation and the use of genetic markers. With these tools it is possible to study the interaction of the major space-occupying cells of the atherosclerotic plaque (especially the arterial smooth muscle cells) with many of the blood components, especially the lipoproteins and the other serum factors that appear to influence cell division. This direction of study appears to usher in a new era of atherosclerosis research.


Biophysical Society. Program and abstracts. Twenty-third annual meeting, February 26-28, 1979, Atlanta, Georgia.


Influence of hemoglobin saturation on temperature correction of measured blood PO2.


The role of clinical chemistry in chemical and drug safety evaluation by use of laboratory animals.


Activities of enzymes in plasma should be measured at 37 degrees C. There are considerable differences of opinion as to the most desirable temperature at which activities of enzymes in plasma should be measured. Debate centers around 25 degrees C because of its widespread use in physico-chemical measurements, 30 degrees C because of its supposed technical convenience, and 37 degrees because of its physiological significance. There is, however, widespread agreement that the activities of intracellular enzymes, and of enzymes having a natural function in plasma, be measured at 37 degrees C. Perhaps because estimations of the activities of those enzymes in plasma that have leaked from damaged tissues have been subject to almost continuous modifications, temperature has simply become just another variable to take into account. In this article I describe the relevance of a temperature near 37 degrees C to the activities of all enzymes in man, intracellular and extracellular. I conclude that 37 degrees C is to be favored as the temperature for assaying all parameters in human biochemistry affected by temperature. These include not only enzyme activities but also pH, blood-gas equilibria, binding data, and, in fact, all kinetic activities in the body.


Secondary hypertriglyceridemia and hyperlipoproteinemia in patients with primary asymptomatic gout. We carefully selected 30 men with primary gout, rendered asymptomatic by therapy, to examine the frequency and type of hyperlipidemia and hyperlipoproteinemia, with the objective of determining whether serum uric acid, alcohol intake, liver function, kidney function, and (or) drugs were participating in the secondary lipid disorder. Sixty-one age- and sex-matched men were used as controls. About 73% of the gout patients had hypertriglyceridemia, 1.6-fold the frequency found in the control group. Types IV and IIb lipoprotein electrophoretic patterns were most prevalent in the gout group. Neither alcohol intake nor hyperuricemia, per se, seems to be the cause of the lipid and lipoprotein disorder and cannot be related to liver or kidney dysfunctions. Obesity was the major underlying factor associated with the lipidemia. The study suggests that diet and, possibly, defective clearance of triglycerides may be etiologic factors associated with the abnormal serum triacylglycerol (triglyceride) and lipoprotein concentrations in these individuals.


Comparison of interlaboratory results for blood lead with results from a definitive method. Results reported by 113 participants in the Blood Lead Proficiency Testing Program conducted by the Center for Disease Control were compared with those obtained by the National Bureau of Standards (NBS) with a definitive methods (mass spectroscopy-isotopic dilution) for blood lead analyses. Data were compiled from the results obtained for 12 whole-blood samples containing 1.5 g of disodium EDTA per liter. Twelve separate blood samples were obtained from cattle which had been given lead nitrate orally. Lead concentrations in the samples ranged from 0.628 to 4.93 mumol/L (130-1020 micrograms/L) as determined by NBS. The methods used by laboratories were classified according to six basic groups: anodic stripping voltametry; and atomic absorption spectroscopy in which either extraction, carbon rod, graphite furnace, tantalum strip, or Delves cup was used. For results obtained in each group a linear regression analyses of laboratory values was made on the basis of NBS values. In comparison to the definitive method, most field methods for blood lead tended to overestimate the lead concentration when the actual lead concentration was less than 1.96 mumol/L (400 micrograms/L) and to underestimate the lead concentration when the actual lead concentration was greater than 2.45 mumol/L (500 micrograms/L).


Influence of a between-run component of variation, choice of control limits, and shape of error distribution on the performance characteristics of rules for internal quality control. A computer-stimulation study has been performed to determine how the performance characteristics of quality-control rules are affected by the presence of a between-run component of variation, the choice of control limits (calculated from within-run vs. total standard deviations), and the shape of the error distribution. When a between-run standard deviation (Sb) exists and control limits are calculated from the total standard deviation (St, which includes Sb as well as the within-run standard deviation, Sw), there is generally a loss in ability to detect analytical disturbances or errors. With control limits calculated from Sw, there is generally an increase in the level of false rejections. The presence of non-gaussian error distribution appears to have considerably less effect. It can be recommended that random error be controlled by use of a chi-square or range-control rule, with control limits calculated from Sw. Optimal control of systematic errors is difficult when Sb exists. An effort should be made to reduce Sb, and this will lead to increased ability to detect analytical errors. When Sb is tolerated or accepted as part of the baseline state of operation for the analytical method, then further increases in the number of control observations will be necessary to achieve a given probability for error detection.


Liquid-chromatographic analysis for methylphenidate (Ritalin) in serum. We describe a "high performance" liquid chromatographic method for quantitating methylphenidate in serum. The internal standard, 4,5-diphenylimidazole, and  serum or plasma sample are extracted in chloroform, evaporated, and redissolved in 20 mmol/L potassium phosphate (pH 3.5)/high-purity acetonitrile, 80/20 by vol. A centrifuged aliquot is chromatographed on mu-Bondapak C-18 with the phosphate/acetonitrile solvent as mobile phase, a flow rate of 1.6 mL/min, and a column temperature of 40 degrees C. Absorbances are read at 192 nm. This method reliably measures concentrations greater than 20 micrograms/L and has analytical recoveries of 74%.


Liquid chromatographic analysis of disopyramide and its mono-N-dealkylated metabolite. We describe a rapid, sensitive, and specific "high performance" liquid chromatographic analysis for disopyramide and its mono-N-dealkylated metabolite in serum, urine, and saliva. We used a mu-Bondapak CN column and an acetate buffer mobile phase containing methanol. Retention times for the two compounds and the internal standard, p-chlorodisopyramide, were 3.4, 4.1, and 6.3 min, respectively. The lower limits of sensitivity for drug and metabolite were 50 and 80 micrograms/L, respectively, with maximum coefficients of variation of 4.6 and 12%, respectively. Currently used antiarrhythmic drugs did not interfere with the analysis of disopyramide, and the pharmacokinetics of the drug, obtained from studies of one subject, agree well with reported values.


Liquid-chromatographic determination of acetaminophen in serum. We describe a sensitive and precise "high-pressure" liquid-chromatographic method for determining acetaminophen in serum. The 2-acetaminophenol and 3-acetaminophenol structural isomers of acetaminophen are used as internal standards. The method, which involves solvent extraction and adsorption chromatography on silica, provides excellent sensitivity, accuracy, and selectivity. The standard curve is linear over the range of acetaminophen concentrations of 0.5 to 300 mg/L, which makes the method useful for both pharmacokinetic studies and overdose monitoring. Analytical recovery is 97% for acetaminophen concentrations ranging from 5 to 300 mg/L. Many commonly used drugs were tested and found not to interfere. The procedure has been successfully adapted as a microscale method requiring only 50 microL of sample. The microscale method is particularly useful for pediatric and neonatal patients for whom sample size is a major concern.


An evaluation of ethylene glycol-based liquid specimens for use in quality control. We investigated the analytical acceptability of ethylene glycol-based control sera by preparing sets of aqueous and ethylene glycol-based specimens that had added uric acid, calcium, creatinine, glucose, urea, sodium, and potassium. Ethylene glycol caused a significant systematic proportional bias in procedures involving dialysis, but had no discernible effect on methods not involving dialysis. The extent of bias was proportional to the concentration of ethylene glycol, was independent of protein concentration, and differed according to the type of dialysis system used. We conclude that ethylene glycol-based control materials can have useful applications in clinical chemistry, but caution must be exercised in their use with analytical systems that employ dialysis.


Cytosine and orotic acid in urine of immunodeficient children. We describe procedures for determining cytosine and orotic acid in urine. We determine cytosine by cation-exchange analysis with either HCl or pH 5.2 buffer as eluent. Orotic acid is first separated by an anion-exchange separative procedure; after lyophilization, the product is subjected to "high-pressure" liquid chromatography for further separation and detection. We analyzed urine from normal subjects and from immunodeficient children. Three children with severe combined immunodeficiency had increased levels of cytosine in urine (23-160 mmol/mol creatinine); one child with severe combined immunodeficiency and two children with other immunodeficiencies had normal urinary levels (less than 2 mmol/mol creatinine). Orotic acid excretion in urine was normal (1-5 mmol/mol creatinine) in all of th immunodeficient children. We discuss the possible significance of the increased cytosine excretion in the three children with severe combined immunodeficiency.


Measurement of alpha-, beta-, and gamma tocopherol in serum by liquid chromatography. A liquid-chromatographic assay for alpha, beta, and gamma-isomeric tocopherols in human serum is reported. The tocopherols and the internal standard (tocol) are absorbed into a silica gel column and are eluted in less than 10 min with n-hexane/isopropanol (99.4/0.6, by vol) at a flow rate of 1 mL/min. The complete analysis requires no longer than 30 min. Within-day precision (CV) was 1.4% (mean = 13.18 mg/L, n = 24), 7.4% (mean = 0.214 mg/L, n = 14), and 1.3% (mean = 1.01 mg/L, n = 14) for alpha-, beta-, and gamma-tocopherol, respectively. Day-to-day precision (CV) was 4.4% (mean = 9.85 mg/L, n = 10) for alpha-tocopherol, 9.1% (mean = 0.222 mg/L, n = 20) for beta-tocopherol, and 3.8% (mean = 1.00 mg/L, n = 20) for gamma-tocopherol. Extraction recoveries for alpha-, beta-, and gamma-tocopherol averaged 92.4 +/- 2.9% (n = 5), 91.4 4/- 7.6% (n = 5), an 92.0 +/- 4.1% (n = 4), respectively. The smallest injected amount detectable is estimated to be 0.03 micrograms for alpha-, and 0.04 micrograms for beta- and gamma-tocopherol.


Effects of wavelength error and spectral band width on measurement of alkaline phosphatase activity. We re-examined the effects of wavelength error and spectral band width on the measurement of alkaline phosphatase activity. The methods we studied is relatively insensitive to these two factors, a conclusion we base on both experimental results and theoretical analysis. These findings are in conflict with a recently published report [Lott et al., Clin. Chem. 24, 938 (1978)], and we suggest a possible explanation for this.


Incorrect least-squares regression coefficients in method-comparison analysis. The least-squares method is frequently used to calculate the slope and intercept of the best line through a set of data points. However, least-squares regression slopes and intercepts may be incorrect if the underlying assumptions of the least-squares model are not met. Two factors in particular that may result in incorrect least-squares regression coefficients are: (a) imprecision in the measurement of the independent (x-axis) variable and (b) inclusion of outliers in the data analysis. We compared the methods of Deming, Mandel, and Bartlett in estimating the known slope of a regression line when the independent variable is measured with imprecision, and found the method of Deming to be the most useful. Significant error in the least-squares slope estimation occurs when the ratio of the standard deviation of measurement of a single x value to the standard deviation of the x-data set exceeds 0.2. Errors in the least-squares coefficients attributable to outliers can be avoided by eliminating data points whose vertical distance from the regression line exceed four times the standard error the estimate.


Automated measurement of total cholesterol and triglycerides, in "tandem," on the discrete sample analyzer, Gilford System 3500. We have developed an automated procedure on a discrete sample analyzer, Gilford System 3500, which alternately measures both total serum cholesterol and triglyceride concentrations as a "tandem" procedure. We used Dow Diagnostic's fully enzymatic, colorimetric reagents and aqueous standards to calculate unknowns ratiometrically. Cholesterol and then triglyceride reagent are dispensed into alternate cups; the produced color at 500 nm is measured after an ambient temperature incubation of 20 min. Reagent and sample carryover is less than 1.6%. Correlation coefficients of 0.997 for comparison for both automated tests with the manual methods at 30 degrees C and a typical CV of less than 2.0% show this "tandem" procedure to be reliable and accurate.


Determination of catecholamines and their 3-O-methylated metabolites in urine by mass fragmentography with use of deuterated internal standards. We report the determination of catecholamines (dopamine, norepinephrine, and epinephrine) and their 3-O-methylated metabolites (3-methoxytyramine, normetanephrine, and metanephrine) in urine by gas chromatography/mass spectrometry, with use of stable isotopically labeled internal standards. Normal excretion values in terms of creatinine, expressed as a function of age, are given, together with results obtained for patients with neuroblastoma, ganglioneuroblastoma, pheochromocytoma, parkinsonism treated with L-DOPA plus peripheral decarboxylase inhibitor, and a patient with cardiogenic shock treated with dopamine. The results obtained for normal adults are discussed in relation to other catecholamine metabolites and mean overall catecholamine turnover.


Macro creatine kinase BB in serum, and some data on its prevalence. We report the case of a patient with persistently above-normal activity of creatine kinase (CK) in serum, a major fraction of which on electrophoresis moved as a band between the MM and MB isoenzymes and on anion-exchange column chromatography eluted in the MB fraction. Measurements in the presence of specific M or B subunit-inhibitory antibodies indicated that 93% of the activity consisted of B-isomers. From these experiments we conclude that the abnormal CK is of BB nature. Gel filtration and immunoglobulin precipitation showed that the CK-BB was complexed with IgG. Normal CK-BB, when mixed with the patient's serum, was converted to macro CK-BB. In vitro stability of 37 degrees C of the abnormal enzyme was much greater than that of normal BB and MM isoenzymes. Following this finding, we then assessed 310 sera, received for enzyme assay by the clinical laboratory, for electrophoretically abnormally migrating CK isoenzymes. Of these, five (1.6%) contained such enzymes, all being of BB nature. They were of increased molecular mass, and at least three of them were complexed with IgG.


Manual fluorometry of phenylalanine from blood specimens collected on filter paper: a modified procedure. In this manual fluorometric method, blood samples are used that have been impregnated on the filter paper, a convenient collection technique that is widely used to screen newborns for phenylketonuria. The modified procedure, based on the method of McCaman and Robins [J. Lab Clin. Med. 59, 885 (1962)], includes elution of phenylalanine from specimens on filter paper, removal of proteins by precipitation with trichloroacetic acid at 0 degrees C, and then reaction with ninhydrin-peptide reagent for color development. The standard curve is linear to at least 200 mg/L and the CV is 6.3% for a phenylalanine concentration of 27 mg/L. The modified procedure is suitable both for early screening for phenylketonuria and for monitoring blood phenylalanine of phenylketonurics during dietary therapy.


Spectral analysis of urinary reactions: a preliminary study based on a novel concept. The concept of spectral analysis of urinary reactions (a range of simple chemical tests combined with pattern analysis) is described. A preliminary study in which we used 10 nonspecific tested on untimed urine specimens from 20 controls and 20 diabetics, matched for age and sex, suggested that a combination of these tests could be used to separate diabetics from healthy subjects. This combination, however, did not prove satisfactory for a further group of 13 diabetics. Closer examination revealed that factors such as therapy and glycosuria affected the results of these tests. This approach, which should extend the usefulness of urinalysis, may prove viable when larger groups, and possibly a different set of tests, are used to establish a more robust combination of tests.


More on interference of sodium azide with measurement of total and conjugated bilirubin in serum.


Improved lysozyme assay in biological fluids. We describe a simple, rapid, sensitive, and highly reproducible assay for lysozyme, with use of concentrated cell suspensions of Micrococcus lysodeikticus in Tris-buffered glycerol/water (40/60 by vol), pH 7.5. Stored at -20 degrees C, the cells' susceptibility to lysozyme remains unaltered over long periods. Almost identical concentration curves were obtained with different aliquots of the same preparation during eight months. Lysozyme activity was reflected in the decrease in absorbance of the reaction mixture after incubation for 15 min at 37 degrees C. Concentrations of egg-white lysozyme as low as 0.02 mg/L can be accurately assayed.


Simplified aseptic separation of cells and plasma.


Constructing a normal range.

Constructing a normal range.


Interference of 4-amino-4-deoxy-N10-methylpteroic acid with the radioimmunoassay of methotrexate.


Relative difficulty of procedures for acetaminophen.


Fluorescent albumin-bilirubin complex on cellulose acetate electropherograms, which may confuse creatine kinase isoenzyme assay.


Interference by lactescence in glycohemoglobin analysis.


Carbamazepine and urinary 17-hydroxycorticosteroids.


Evaluation of the creatine kinase MB kit of Boehringer.


Rapid immunochemical determination of free hemoglobin in plasma and urine with a laser nephelometer.


CT anatomy of the nasopharynx, nasal cavity, paranasal sinuses, and infratemporal fossa. Analysis of anatomical features of the nasopharynx, nasal cavity, paranasal sinuses, and infratemporal fossa was carried out by retrospective review fo 50 CT scans. Conventional and axial anatomy are discussed, and normal size limits of selected structures are proposed on the basis of a series of measurements. Examples of early and advanced disease are shown.


Computed tomography of intracerebral gangliogliomas. CT and clinical findings in 6 histologically proven cases of intracerebral gangliogliomas (out of 14,000 cranial CT examinations) are presented. The tumor is most often isodense, with areas of calcification. Even though CT findings are nonspecific, they are suggestive of the benign nature of the tumor. When this is histologically confirmed (by biopsy) the more aggressive forms of treatment may be obviated.


Clinical evaluation of thyroid CT values in various thyroid conditions. CT scans of the thyroid were performed with a Hitachi CT-W2 device. The CT value of the region of interest (ROI) was obtained from CT images of the thyroid. Mean and standard deviation was 112 +/- 10 in 44 normals. Out of 27 cases of hyperthyroidism, the CT value of 13 untreated cases of 58 +/- 4, and that of 13 cases under treatment was 73 +/- 7 in average. The CT value of the single cured case was 100. Twelve cases of chronic thyroiditis and 5 cases of hypothyroidism showed averages of 57 +/- 11 and 36 +/- 13, respectively. The results of the above-mentioned clinical study indicate the estimation of the CT value of the thyroid is useful for diagnosis of various thyroid conditions.


Hyperglycemia-induced hyponatremia: a fresh look.


A primer in computed tomographic anatomy. VII. Peritoneal and extraperitoneal compartments, spaces, and fasciae.


Current cases & concepts.

Current cases & concepts.


A primer in computed tomographic anatomy. VIII. The upper extremity.


Current cases & concepts: xanthogranulomatous pyelonephritis.


Computed tomography of the left gonadal vein.


Evaluation of subarachnoid hemorrhage and cerebral vasospasm by computed tomography. The CT findings in patients with subarachnoid hemorrhage include visualization of the aneurysm (10% of the cases), subarachnoid, intraventricular, or intracerebral hemorrhage (87% of cases scanned within five days), "ischemic" lucency secondary to spasm (10%), and hydrocephalus (54%).


Mass lesions of the retroperitoneum (excluding specific organs). The value of computed tomography (CT) in the diagnosis and management of retroperitoneal masses is discussed. Neoplastic, inflammatory, and hemorrhagic conditions are shown. In addition to facilitating the detection of these mass lesions, CT is especially valuable in allowing accurate biopsies and aspiration to be performed and in the follow-up of the patient.


Computed tomography of choroid plexus lesions. Computed tomographic (CT) and clinical findings in 14 patients with 17 lesions of the choroid plexus are presented. Primary neoplasms are the most common lesions in this series and include papillomas, meningiomas, carcinoma, astrocytoma, and teratocarcinoma. There are five vascular lesions, consisting of cavernous angiomas, hemangiomas, and an arteriovenous malformation. One patient had bilateral xanthogranulomas. There was association between cavernous angiomas and Sturge-Weber, and between meningiomas and neurofibromatosis. Useful distinguishing clinical and CT features between the different types of lesions are discussed.


Renal arteriovenous malformation presenting as a mass lesion. Arteriovenous malformations of the kidney are definitively diagnosed by selective arteriography (1). The following case is unique in that it presented as an avascular mass and the lesion itself could not be demonstrated angiographically.


Subdural hygroma: diagnosis with computed tomography. Nine cases are reported that fulfilled the criteria for diagnosis of subdural hygroma. With the availability of serial computed tomographic (CT) scans, it is possible to document non-invasively the appearance of CSF-density subdural fluid where no prior blood accumulation has been present.


Computed tomographic scanning of the left upper quadrant and left flank: advantages and pitfalls.


Normal anatomy and limitations in CT interpretation of lymph node disease. The CT appearance of normal retroperitoneal lymph nodes has been described. In many instances the structures are too small to be identified. other retroperitoneal structures, such as collapsed bowel loops, vessels, and other perirenal structures, may simulate the presence of nodes. CT is of great benefit in disease with bulky tumors, such as non-Hodgkin's lymphoma, testicular tumors, etc. Its usefulness is much more limited in disease that may have extensive nodal involvement but no significant enlargement of the nodes. The accuracy of CT scanning in Hodgkin's disease and in many instances of genitourinary tumors is questioned, and we submit that further studies are needed to establish the reliability of this mode of examination.


Quantitative evaluations of CT values of in vivo abdominal organs: application to the liver and spleen.


Portal vein ectasia simulating a vascular lesion in the pancreatic head in an enhanced CT scan. An ectatic portal vein in a patient with portal hypertension and chronic active hepatitis simulated a vascular lesion in the head of the pancreas in a contrast-enhanced CT scan.


Computed tomographic anatomy of the lung segments in the sagittal, coronal, and transverse planes--experimental study in a lung model.


The role of radionuclide brain imaging and computerized tomography in the early diagnosis of herpes simplex encephalitis. We have reviewed the medical records and radiographic examinations of 12 patients with herpes simplex encephalitis to assess the role of RN and CT in the early diagnosis of this disease. The initial RN study was positive in 83% (10/12) of cases while the initial CT study was positive in 75% (9/12) of cases. The earliest positive RN was seen on the second day after the onset of neurologic signs or symptoms while the earliest positive CT was seen on the third day. We describe various abnormal patterns encountered in HSE and discuss their diagnostic reliability. We make recommendations for the diagnosis of HSE based on our findings and on the information available in the literature


Single-unit discharges in the dorsolateral thalamus of behaving cats: spontaneous activity.


Neural activity from motor cortex in visuobehavioral deprivation.


Effect of undernutrition on cerebral protein metabolism.


Single-unit discharges in the dorsolateral thalamus of behaving cats: ictal activity.


Normal loss of milk teeth causes degeneration in brain stem.


Visual-evoked response in lateral hypothalamic neglect.


Feedback control of human lip muscle.

Feedback control of human lip muscle.


Variation in conduction velocity during the relative refractory and supernormal periods: a mechanism for impulse entrainment in central axons.


Substantia nigra and pentylenetetrazol threshold in rats: correlation with striatal dopamine metabolism.


Similar in vitro fatigue patterns of normal and BIO 40.54 dystrophic hamster extensor digitorum longus muscle.


Intracranial self-stimulation, cortical arousal, and the sensorimotor neglect syndrome.


Determination of the osmotic potential for swelling of cat brain in vitro.


Anticonvulsant effects of restraint and pyridoxine on hydrazine seizures in the monkey.


Reaction of the mutant mouse nude to axonal injuries of the central nervous system.


Trigeminal nerve and temporomandibular joint of the cat: a horseradish peroxidase study.


Tonsillectomy in Manitoba: who are the patients? the surgeons? the hospitals? Although tonsillectomy-adenoidectomy rates are declining across North America, this paper suggests they are not falling fast enough. More than half the cases coming to surgery fail to meet accepted standards regardless of who performs the surgery, or where it takes place. Family surgery is still fairly common and is almost never indicated. While younger physicians have higher standards of selection, they are not doing any less T and A surgery than their older colleagues; in fact younger general surgeons are doing more. This study concludes that non-indicated T and A surgery is still a prevalent problem, deserving of widespread attention.


Where do cancer patients die? A review of cancer deaths in Cuyahoga County, Ohio, 1957--1974. The great concern over the status and care of the dying cancer patient requires the understanding of current trends in care. An 18-year review of 55,288 death certificates of patients with cancer in Cuyahoga County, Ohio (1957--1974) revealed that 35,381 patients (65%) died in acute and chronic care hospitals, 8,251 patients (15%) died in nursing homes, and 11,242 patients (20%) died at home. Trends over the 18-year period demonstrated a shift from patients dying at home to patients dying in nursing homes. The hospital care of dying cancer patients remained unchanged during the study period. An analysis of 33 consecutive patients dying of cancer over a six-month period in an acute care hospital in Cuyahoga County showed an average length of stay of 20.1 +/- 15.7 days, during which only palliative care was provided. The cost benefit of home care/hospice programs is related to the final hospital stay of the dying cancer patient.


Longitudinal study of career choices of a SUNY-Upstate cohort of medical students. A SUNY-Upstate cohort was observed during the four-year matriculation (1974--1978) of the students for changes in their career choices. Medical school exposure seemed to increase students' interest in all major specialties, with the exception of family practice for which there was an overall 3% decrease. Internship and residency appointments accepted indicated that 75% entered primary care specialties, 8% more than the national average for 1978.


Recent status of detection, treatment, and control of hypertension in the community. The Hypertension Detection and Follow-up Program (HDFP), a national collaborative study, screened approximately 159,000 people for high blood pressure in 14 communities between 1973 and 1974. Results show that detection, treatment, and control of high blood pressure has improved considerably since the 1960s. Whereas in the past about half of all hypertensives knew they had high blood pressure, half of those detected were under treatment, and half of those under treatment had their high blood pressure under control, the corresponding percentages in the 14 HDFP communities a decade later indicate that 75% of hypertensives were detected, 72% of those were under treatment, and 70% of those under treatment had a diastolic blood pressure under 95 mm Hg. While the differences in prevalence of hypertension are between races rather than sexes (with black individuals in some age groups being about twice as likely as white individuals to have hypertension), the differences in detection and treatment rate are largely between sexes and not between races. Women are considerable more likely to be aware of their hypertension, to be under treatment for it, and to have their high blood pressure under control. Rates of control vary considerably among age-sex-race subgroups, from only 8% of white male hypertensives aged 30-39 to 67% of white female hypertensives aged 60--69. It appears that although efforts to combat this disease over the past decade have probably made considerable progress in improving the recognition and treatment of high blood pressure, there remain a large number of undetected, untreated, and uncontrolled hypertensives.


Determinants of dropout rate among hypertensive patients in an urban clinic. Noncompliance with follow-up is a serious problem in the management of hypertension. A retrospective cohort study examined dropout rates and their determinants among 249 randomly selected outpatients with essential hypertension from the medical clinic of an urban teaching hospital. Data were abstracted from hospital records and a subset of dropouts was interviewed. A lifetable analysis revealed that patients who were initiating therapy or who had been under therapy for less than six months had a 50% chance of remaining in care two years later, while 70% of patients who had been under therapy for more than six months at entry were still in care after this period. Patients who were less severely ill by several indicators were the most likely to drop out. It is hypothesized that the low perceived severity of illness, coupled with the costs and inconvenience of care and the lack of physician enthusiasm for the treatment of mild hypertension leads to non-compliance with follow-up.


Potentiation of propanidid, ketamine and althesin anaesthesia by diazepam.


The effect of propranolol on the serum lipids in diabetics with coronary heart disease.


Malignant melanoma of the nose and nasopharynx, "report of three cases".


Gastric hypersecretion after small bowel resection.


Anoplasty for anal stricture.

Anoplasty for anal stricture.


Ochronosis.

Ochronosis.


Studies on bladder stone disease in Egyptian children. VIII. Biochemical studies of the urine.


Surgical correction of portal hypertension caused by schistosomal hepatic fibrosis.


The rate of diffusion of urea to the C.S.F. in diabetics.


The effect of metformin on individual amino acid absorption.


Diasorb 1. A dialyzer that combines absorption, dialysis and ultrafiltration.


Phosphate removal using hollow fibers containing aluminium oxide.


Changes in rat lung produced by olivine dust inhalation.


Erythrocyte vacuoles and pits. I. A study in a case of congenital asplenia syndrome.


A case of gastric leiomyoblastoma with metastasis to the liver.


Endodermal sinus tumor in a 63 year old female.


Covalent structure of the collagen types: structural studies on type I, type II and type III collagen.


The structure of the collagen fibril.

The structure of the collagen fibril.


The special state of the fibril end: site of growth, point of cell surface attachment and possible site for platelet interaction. The end of the collagen fibril is an important and unique morphological site. Growth of fibrils in vitro and in vivo appears to occur by addition of ordered subassemblies of collagen aggregates at the fibril end. In tissues the fibril end appears closely related to the cell surface in both mesenchymal cells and epithelia. In the latter cell type there is an apparent relationship between the basement membrane and fibril end. Platelets do not aggregate upon exposure to basement membranes or collagens derived therefrom. We suggest that the end of the fibril which is embedded in the outer face of the basement membrane may be involved in interaction with the platelet.


A biochemical approach for quantifying and localizing collagen types.


Primary hemostasis (collagen-platelet interaction): introduction.


Reactivity of platelets with different collagens: overlook.


The specificity of the reaction of collagen with platelets. 1. Human platelets will react with a number of different collagens from guinea-pig to ostrich. 2. Human skin collagen when treated with pepsin does not react with human platelets. 3. Calf platelets display a different pattern of reactivity than that of human platelets.


Primary steps in platelet -- collagen interaction.


Structural aspects of type I collagen required for its interaction with platelets.


The specific binding of collagen-alpha 1-chains to platelets.


Fine structure and surface features of platelets and megakaryocytes.


Platelet -- vessel wall dynamics.

Platelet -- vessel wall dynamics.


The cells involved in the process of wound repair.


Developmental changes of the collagen in normal dermis and in wound healing.


A possible effect of epithelialization in the type of collagen formed in scar tissue.