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A case of Lermoyez's syndrome was investigated by tone-burst electrocochleography in both a period of impaired hearing and in a period of almost normal hearing. The changes in threshold values, compound action potential waveforms, input-output curves, and amplitude-latency curves for the compound AP, are described. The electrocochleographic data are compared with the psycho-acoustic data for this case and with electrocochleographic results in a group of 22 Meniere cases. Although the symptoms of vertogo and hearing impairment in Lermoyez's syndrome occur in the reverse sequence, as compared with the classical Menière attack, the data obtained in this case of Lermoyez's syndrome do not differ substantially from those obtained in a group of Menière cases.

Under constant visual guidance and closed-circuit television monitoring, electrodes are inserted into the fluid spaces of the organ of Corti. The resting electrical potentials are determined with respect to the neutral voltage of the guinea pig and related to other potentials of the auditory labyrinth. The resting potential of the subtectorial space, inner sulcus, tunnel and other spaces of Corti's organ are found to be the same as, or slightly more negative than the potential of perilymph. The tectorial membrane isolates the reticular lamina from endolymph which fact, when considered along with other evidence, indicates a more biophysical than mechanical role for the membrane. A motion picture is presented showing the cells and spaces of the organ of Corti and the placement of electrodes.

In our attempts at establishing a cancer cell line from various ascites of cancer bearing patients, a cell line was successfully established from the ascites of a 63-year-old female with primary ovarian tumor (embryonal carcinoma). Histological findings of the peritoneum, due to metastasis, appeared to be cystadenocarcinoma, revealing the differentiation to non-epithelial cells which formed coarse networks and fibers, and morphologic changes of tissue cultures also reflected such histologic findings. At present the subculture has reached the 95th population doubling level, and cultured cells have assumed the morphology of mesothelial cells or fibroblasts with about 50 chromosomes. As a human malignant cell line, it is useful for the study of human malignant tumor cell.

The value of the binaural resynthesis test administered according to Matzker's principle can be estimated only when a comparable monaural test can be used as a control. The most common positive finding in the filtered speech test is asymmetrical discrimination. Both parts of the message delivered to either ear must therefore have the same intelligibility in normal material. Binaural intelligibility is highly resistant to degenerative changes in the auditory system, for example. Positive findings in the binaural test are encountered frequently in brain stem lesions with vascular or traumatic aetiology.

The program of the electronystagmographic examinations in the pathology of the central nervous system contains 11 groups of tasks. Sixty signs of central impairments are listed, from which 26 nystagmic irregularities had a small diagnostic value. No sign occuring alone could be taken as pathognomonic, only a group of signs can be used for the impairment localization. Besides for the peripheral vestibular and the peripheral vestibulocochlear impairments, the authors succeeded to make a group containing pathogomonic signs for mixed vestibular impairments as well as for multiple sclerosis affecting vestibular structures.

The present study was designed to test the hypothesis of "schizophrenic spectrum" disorders. The families of 60 process schizophrenics were systematically interviewed with structured interview forms, and evaluated for psychiatric illness according to strict diagnostic criteria. The interviewed persons were then separated into two groups for comparative analysis according to a positive (FH+) or negative (FH-) family history for schizophrenia. The frequencies of affective disorder and all non-psychotic conditions did not differ to a convincingly significant degree between the two groups. Our data thus fail to support the "schizophrenic spectrum" hypothesis in which neurosis and sociopathy occur as a consequence of a genetic loading for schizophrenia.?

A step-by-step analysis of Beck's and Hamilton's rating scales showed that both scales failed to differentiate adequately between moderate and severe depression measured by a global clinical assessment. Each item of the scales was tested for calibration, ascending monotonicity, and dispersion parallel to the clinical assessment. Twelve items of Beck's scale and six items of Hamilton's scale were found valid with respect to these criteria. Those items should be taken into account in future research for baseline ratings and for change ratings of depressive states quantitatively.

Among 2,619 patients admitted to a medical department for duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray, admissions to psychiatric departments were investigated. A total of 20.4% of the patients had at some time during their lifetime been admitted, but no significant differences were observed in percentage among the three ulcer groups or the sexes. The incidence of psychoses was close to the expected, whereas neuroses among women and neuroses and psychopathy among men were far in excess of the expected. Among those operated on, the percentage of persons admitted to a psychiatric department was greater than among unoperated patients and their number of admissions per 100 observation years were significantly greater than for unoperated patients, within well-defined observation periods. For patients operated on, only men with duodenal ulcer had significantly more admissions per 100 observation years in the postoperative than in the preoperative period. The course of the disease was more severe for patients with duodenal and gastric ulcer admitted to a psychiatric department than for those not admitted, but the subjective status at the time of the follow-up did not differ between the two groups. Among men, there were a number of heavy drinkers, especially among those operated on.

A follow-up of 35 patients first diagnosed as having presenile dementia at York Clinic is described. In only 15 cases did progressive deterioration confirm the diagnosis. A retrospective case note study of all the patients is described comparing the clinical features and results of special investigations of those patients in whom the diagnosis was confirmed in this way and those in whom it was not. The results of this study are used to illuminate some of the special difficulties in the early diagnosis of presenile dementia.

A survey of 22 patients operated on with left ventricular (LV) infarctectomy during 1967-72 is given. Clinical, haemodynamic and angiographic results are discussed. In most patients, in whom pre- and postoperative examination was possible, there was improvement concerning anginal pain, dyspnoea and attacks of ventricular tachycardia. Exercise studies revealed a lower heart rate at follow-up. In general, heart size had decreased. Angiographically, there was a decrease in end-diastolic and end-systolic heart volume postoperatively, with an increased LV ejection fraction.

Diazepam has been used to an increasing extent in cardioversion, since avoiding general anaesthesia simplifier the procedure. The present study concerns the effect of diazepam on BP and blood gases in 13 cases of cardioversion. A moderate fall of both systolic and diastolic BP occurred. The arterial pO2 and pCO2 did not change significantly.

The renal climination of vancomycin has been determined in 18 patients. In 4 anuric patients in intermittent haemodialysis the dosage of vancomycin necessary to treat infection with penicillin-resistantstrains of Staphylococcus aureus was determined. In 14 patients with varying degrees of renal insufficiency vancomycin, creatinine and 125-iothalamate clearances were measured and found to be closely correlated. After administration of the initial vancomycin dose and attainment of the serum concentration desired, the maintenance dose can be calculated on the basis of the GFR.

Four patients with benign monoclonal immunoglobulinaemia and associated glomerulopathy are described. Immunohistochemical investigations of the immunoglobulin-containing cells in the bone marrow revealed an unexpectedly pronounced predominance of monoclonal over polyclonal cells as typically seen in macroglobulinaemia and multiple myeloma, but in contrast to the malignant plasma cell proliferations the percentage of immunoglobulin-containing cells only constitued 6-12% of the nucleated cells. The possible pathogenetic mechanisms relating monoclonal immunoglobulinaemia and glomerulopathy are unknown. The sera did not contain antibodies to glomerular basement membrane, cryoglobulins, antinuclear factors or antiglobulins. The immunohistochemical technique certainly offers a clear advantage over conventional bone marrow cytology in the study of patients with monoclonal immunoglobulinaemia.

The plasma concentrations of free fatty acids (FFA), glycerol and insulin as well as the blood glucose concentration have been followed in two groups of subjects after infusions of theophyllamine. Each individual was examined twice. The 5 subjects in group 2 were given an infusion of norepinephrine before the theophyllamine at one of the examinations and saline at the other. The 6 subjects in group II were given an infusion of norephinephrine at both examinations, followed by theophyllamine on one occasion and by saline on the other. Thus, the subjects in both groups served as their own controls. It was found that theophyllamine caused lipid mobilization, as measured by the plasma FFA and plasma glycerol concentrations, both when given as the only active drug and when given after norepinephrine. The blood glucose concentration rose slightly after norepinephrine and the plasma insulin level increased concomittantly. When theophylline was given as the only active drug, there was no increase in the blood glucose but the plasma insulin concentration rose slightly.

Oral, intracubital, and intraportal glucose tolerance tests have been performed on 7 non-obese non-diabetics, and glucose and insulin concentrations have been followed in the peripheral and portal blood. A significant rise in portal glucose and insulin was found 1/2-2 min after oral glucose intake. There was no lag between the rise in insulin and glucose concentrations. The portal glucose concentration after oral glucose intake was significantly higher than after cubital glucose infusion for 45 min, although the peripheral glucose concentrations were identical. In the cubital vein the insulin concentration after oral glucose intake was significantly higher than after i.v. glucose infusion, but in the portal blood there was no difference. After portal glucose infusion the cubital insulin concentration did not differ significantly from the concentration after i.v. glucose infusion. Thus, it seems unlikely that a high portal glucose concentration is responsible for the higher peripheral insulin concentration after oral glucose intake. A high portal glucose concentration does not seem to influence the hepatic uptake or release of glucose.

The removal of exogenous triglyceride (TG) in forearm muscle and subcutaneous tissue of 7 healthy male volunteers has been studied by nephelometric determinations of arterial-deep venous (a-dv) and arterial-superficial venous (a-sv) differences in concentration of fat particles. Exogenous TG was administered as a constant i.v. infusion of Intralipid over a period of 30 min at reat and another 15 min during forearm work. At rest a significant positive a-dv difference in fat particle concentration of 121 plus pr minus 21 mumol TG/l (mean plus or minus S.E.M.) was found, which correspondens to a fractional extraction of 1093 plus or minus 2.0%. Also the a-sv difference was significant, 81 plus or minus 14 mumol TG/l, 5.7 plus or minus 0.8% of the arterial concentration. During exercise no further significant removal was found. Thus both skeletal muscle and subcutaneous tissue seem to be able to remove exogenous TG in substantial amounts under resting conditions. In the exercising muscle, however, the direct removal of exogenous TG does not seem to be of significant importance.

The fatty acid spectrum of adipose tissue (AT) lipids has been determined in 43 apparently healthy men with different levels of plasma triglycerides (TG) and different degrees of glucose tolerance (GT). Compared to men with normal plasma TG levels those with hypertriglyceridemia (HTG) had a similar percentage of linoleic acid (18:2) but lower amount of fatty acids, tentatively identified as linolenic (18:3) and arachidonic (20:4) acid. Men with HTG also had lower k-values for the i.v. GT. The content of 18:3 and 20:4 was positively correlated to the k-value of the GT and negatively to plasma TG. These correlations were independent of each other. As usual there was a negative correlation between plasma TG levels and the k-value, which however disappeared after partial correlation analysis when 18:3 was kept constant. Apparently a low content of 18:3 in AT is common both in HTG and glucose intolerance (GI) and might partly explain the often seen association between these two metabolic abnormalities. Since the content of 18:2 was normal it is suggested that the low amount of 18:3 and 20:4 was caused by metabolic rather than dietary factors. The possibility that a low content of 18:3 and 20:4 might play a role in the pathogenesis of GI and HTG is discussed.

The acetylation of procaine amide has been studied by means of gas liquid chromatography in 33 healthy human volunteers. The acetylator phenotype was determined by measuring unchanged and acetylated sulphapyridine in urine. Slow acetylators of sulphapyridine excreted significantly less procaine amide in acetylated from in the urine than rapid acetylators (9 plus or minus 1% against 19 plus or minus 4%). Hence, it is suggested that the acetylation of procaine amide is subject to the same genetic polymorphism as that of isoniazid and some sulfonamides.

Twenty-three out-patients with mild or moderate essential hypertension have been treated with a combination of hydralazine (37.5-150 mg daily) and oxprenolol (60 mg daily). Before treatment the patients were phenotyped for polymorphic acetylation by means of the sulphamethazine test: 12 proved to be slow and 11 rapid acetylators. A significant correlation was found between daily doses of hydralazine and the plasma hydralazine levels, separately in slow (r=0.480) and in rapid (r=0.580) acetylators. The antihypertensive response to hydralazine correlated well to plasma hydralazine levels. The mean fall of BP in slow acetylators was 33/23 mmHg in supine and 20/18 mmHg in standing position. The corresponding values in rapid acetylators were 22/15 and 21/15 mmHg. The average daily doses of hydralazine needed for these responses were 1.3 mg/kg in slow and 1.6 mg/kg in rapid acetylators. To reduce the systolic BP by 20 mmHg, 1.0 mg/kg of hydralazine was needed in slow acetylators; rapid acetylators needed a significantly higher dose of 1.4 mg/kg. During a follow-upof 1 year there have been virtually no side-effects. The results tally with the previous finding of Zacest and Koch-Weser, who demonstrated a similar correlation during the triple-drug regimen. It seems as if hypertensive patients can be succesfully treated with hydralazine and beta-blocking drug without knowledge of the patient's acetylator phenotype. However, acetylator status is a determinant of tissue levels and long-term toxicity of hydralazine, and patients should be phenotyped because beta-blockers may mask the warning side-effects.

Urinary excretion of antimony, arsenic, bromine, cadmium, caesium, cobalt, copper, gold, iron, mercury, molybdenum, ribidium, scandium, selenium, silver, tungsten and zinc from five hypertensive patients beforeand during treatment with hydralazine has been investigated. The method consisted of neutron activation analysis combined with a recently developed ion exchangee technique. The mean copper excretion during treatment with hydralazine was found to be more than twice that before treatment.

One hundred and four patients with Hodgkin's disease have been studied retrospectively in order to evaluate the relationship between fever associated with the disease (Pel-Ebstein type) and the development of anaemia. In the material 19 episodes of fever were found to be of this type. The mean loss of Hb during a fever period was 14% (range 2-33). From the rate of decrease in Hb it was deduced that this was at least partly caused by an increased destruction of erythrocytes. There was a significant correlation between the thermal exposure (expressed either as the duration of fever, the maximum body temperature during the fever period, or the sum of the temperature maxima) and the degree of erythrocyte loss. The loss of Hb was self-limited in spite of persistent fever. Furthermore, there seemed to be an inverse relationship between the degree of preexisting anaemia and the fever-induced relative loss of Hb. A possible explanation is that the older part of the erythrocyte population is more sensitive to the effect of fever.

Leo 1031, a chlorambucil ester of prednisolone, has been administered orally to 15 patients with chronic lymphocytic leukaemia (CLL) continuously for 1-29 months (mean 12.5). Seven patients were previously untreated and eight had been treated with prednisolone, radiotherapy and/or alkylating agents. The initial daily dose was generally 8-16 mg and the maintenance dose was 6-8 mg. Allopurinol was given concurrently. In 14 of 15 patients a reduction of the leucocyte count was observed and a reduction, in most instances, of lymphadenopathy or splenomegaly, or both. In seven patients the Hb concentration was improved. Significant toxic effects on bone marrow function have been observed in one patient. Two patients developed urticaria. Our study suggests that the drug is effective in the treatment of CLL.

A 25-year-old man presented with severe hypertension associated with hypokalemia, elevated plasma renin level and secondary hyperaldosteronism. Malignant phase hypertension and renal artery stenosis were ruled out, and a preoperative diagnosis of renin-secreting renal tumour was made on the basis of higher concentrations of renin in the left than in the right renal venous plasma in spite of normal findings on selective renal arteriography. By removal of the affected kidney the tumour was found and it had a very high content of renin. Following the operation the plasma renin level, serum aldosterone concentration and BP became normal. We present a histopathological description and an ultrastructural study of the tumour.

The effects of bilateral partial prefrontal lesions on go-no go differentiation with symmetrical or asymmetrical reinforcement trained by the avoidance procedure were investigated. Moderate impairment of these tasks was observed after large lateral or medial prefrontal lesions, while severe impairment after a deep incision of the fibers in the specific prefrontal region. It is suggested that the mechanism of avoidance differentiation is of a symmetrical type, which is directly related to the "motor act differentiation" but not to the drive-no drive differentiation.

In dogs with chronic parotid fistula, conditioned salivary reactions reinforced by food were established. After bilateral lesions of the dorsomedial part of the amygdaloid complex, the conditioned salivary reactions were greatly diminished. Also the unconditioned salivation decreased. This decrease was greater in dogs which revealed the whole syndrome of amygdalar aphagia, but it was also evident in hypophagic dogs. In some dogs, the disinhibition of the salivation to negatives CS was also observed. Results show that the dorsomedial amygdala, similarly to lateral hypothalamus, is involved in the regulation of salivary reactions.

Dogs were unable to learn "same-different" differentiation of pairs of photic stimuli when continuous light (CL) and pulsing light (PL) were presented in four combinations: CL-PL and PL-CL served as S(D) (positive instrumental conditioned stimulus), whereas CL-CL PL-PL were S delta (inhibitory stimulus). Also the dogs which have learned this task with tones were unable to transfer to photic stimuli. Differentiation of the single stimuli (CL and PL) as S(D) and S(delta) was quite easy and showed that the stimuli were readily discriminable.

Four dogs, previously trained to perform on the "same-different" differentiation with tones transfered readily to the same task with new stimuli of the same (auditory) modality. The data are interpreted as an support for the "matching" hypothesis and a disproof of the notion of "conditioned switching".

One hundred cells of the visual cortex were studied using flashes, clicks and light-sound combinations with different delays. Forty nine neurons changed the total number of spikes to click stimulation. Twenty eight cells responded to clicks with specific response pattern. In 23 cells the initial discharge occurred at 60-70 ms after the onset of clicks. In 39 cells the responses to light-sound combinations differed from the responses to flashes. While 16 cells decreased their responses, the addition of sound increased firing in 23 cells. The specific modification of the light-evoked responses under acoustic stimulation were classified into three main categories: 22 cells generated new response patterns, 18 cells showed a re-distribution of peaks in the PTS histogram and three cells demonstrated a desynchronization of the spike discharge. The study of the heteromodal recovery cycle revealed that the majority of the cells increased their firing during 0-100 ms and decreased firing during 200-300 ms of the response time scale. The critical delays between light and sound, resulting in the modification of the response for the majority of the cells, were within 100 ms in both directions.

Cats deprived of pattern vision with hoods and normal cats were used. During the first 3 months of life some hood-reared cats had visual experience with a three-dimensional cross or a ping-pong ball. Recording were performed in adult cats with a pretrigeminal brainstem transection. Unit responses to the cross and the ball were recorded in area 19 within the projection of area centralis. Stimulus-dominance of the exposed object was manifested weakly. Both exposed and control objects activated more units in the experienced hood-reared cats than in hood-reared and normal controls. Compared with previous finding, the present results indicated that early visual experience affects area 19 differently than areas 17 and 18.

The interaction between kinins formed in central nervous system and acetylcholine was studied. Endogenous ACh in excess acted psychodepressively on the animal's behavior as evaluated with Lat's test. This effect was more intense in those rats in which the activity of kinin-forming enzymes in the nervous tissue had been increased with either kallikrein or bradykinin. Both kallikrein and bradykinin intensified the psychodepressive action of exogenous ACh given into the brain ventricle. Results show that kinins can enhance the inhibitory central action of ACh.

The investigations deal with the pharmacological activity of albumin degradation products. The peptides which resulted from 30 min trypsin digestion of human albumin exhibited some kinin-like effects. The peptides given intraperitoneally and intraventricularly revealed a central inhibitory action, the strength of which was similar to kinin effects.

The participation of intraventricular conduction defects in the AV delays and blocks has been investigated by His bundle electrogram recording in 239 patients with different degrees of AV blocks and QRS enlargement (greater than 0.12 sec). In absence of PR prolongation, the His bundle electrogram can demonstrate intraventricular conduction delay (HV superior to 55 msec) with an increasing frequency in right bundle branch block and right bundle branch with left axis deviation, left bundle branch block and right bundle block with right axis deviation. In cases of first-degree AV block (PR greater than 0.20 sec) delay within the His bundle is present in 20% of the cases and HV prolongation, isolated or associated with an upper conduction defect is demonstrated in 66% of the cases. Second-degree AV block with QRS enlargement in the conducted beats is due to a subnodal lesions of the conducting tissue in 80% of the cases. Wenckebach phenomenon and bundle branch block is as frequent above as below the site of His bundle electrogram recording. Möbitz II block has always an infranodal localization. Third-degree AV block with wide QRS complexes is the consequence of a lesion within the His bundle in 11% and of a complete bilateral bundle branch block in 78% of the cases. Exploration of the AV conduction in acute myocardial infarction with AV block confirms the usual bilateral bundle branch lesion in anterior myocardial necrosis and the AH localization of the AV block in posterior myocardial infarction even in presence of enlarged QRS complexes. Unidirectional block occurs in 19 of the 82 cases of complete anterograde bilateral bundle branch block, with retrograde conduction to the atria in 11 and concealed retrograde conduction in 8 cases.

In patients with WPW syndrome the maximal ventricular rate attained during ectopic rapid supraventricular thythms depended on the type of arrhythmia as well as on the physiological properties of the AP. During reciprocating tachycardias the impulse is almost invariably conducted to the ventricles through the AV node. Therefore, the maxiaml ventricular rate is a function of the AV nodal ERP. On the other hand, when atrial flutter or atrial fibrillation were present the ventricular rate could be moderately elevated (when the ERP of the AP was longer than that of the AV node) or very rapid where the ERP of the AP was significantly short. Therefore, from the electrophysiological viewpoint, the AP appears to behave as His-Purkinje tissue in some cases and as ordinary artrial muscle in other patients. These assumptions await further documentation.

Electrical stimulation of the heart, using the single test stimulus method, gives the opportunity to study the mechanisms of tachycardias and the effect of drugs on these mechanisms directly in the heart of the patient with the WPW syndrome. Using these methods the effect of digitalis, procainamide, quinidine, ajmaline, lidocaine, propranolol and verapamil has been studied. Understanding of the mechanisms responsible for initiation and maintenance of tachycardias and the way in which they can be influenced by drugs should be of help in the treatment of the symptomatic patient with the WPW syndrome.

Computer criteria for LAHB and LPHB were described together with limits of normal for ortogonal leads. These differ significantly from those used for conventional 12-lead ECG, indicating the need for specific LAHB and LPHB criteria in orthogonal electrocardiography. Multivariate analysis with a likelihood ratio test was used for the separation of records with conduction defects with and without MI. The total number of records was 847. The recognition rate for MI in the presence of LVCD was 66%. In the presence of RVCD, MI was diagnosed correctly in only 55%. This relatively poor result was probably due to the relatively large number of combinations of RCVD with LAHB or LPHB.

In a series of 840 cases of unselected complete LBBB, 2 groups were compared with each other, one of 174 cases of complete LBBB with a QRS axis markedly deviated leftward, from minus50 to minus 90 degree (group A), the other 434 complete LBBB with a normal QRS axis included between minus20 and plus30 degree (group B). Group A differed from group B by the etiological predominance of primary cardiomyopathies, the lesser frequency of hypertensive and/or coronary heart disease, the rarity of idiopathic complete LBBB. It was commonly combined with marked enlargement of the X-ray heart shadow, with marked widening of QRS complex and had a definitely more severe prognosis. The anatomical study performed in 88 cases (52 group A, 36 group B) showed on thw whole a slightly more enlarged heart and a more marked left ventricular dilatation in group A. There were no differences in the state of the coronary arteries and in the frequency of myocardial infarction. Microscopical examination of the left bundle branch, performed in 42 cases (25 group A, 17 group B), showed the habitual and intense changes of the bundle branch, but without obvious difference between the 2 groups concerning the topographical distribution of the lesions.

Using the Dürrer electrode needle to record the intramural electrogram and a standard peripheral electrocardiogram (ECG) lead as reference, the authors studied the action of 9 different drugs in the conduction system of dogs. The authors concluded that diphenylhydantoin and lignocaine would be useful in dysrhythmias related to increased excitability and perhaps increased automatism. Ajmaline and quinidine may be some of some interest in dysrhythmias due to conduction disturbances; and, finally, ajmaline, diphenylhydantoin, di-isopyramide and quinidine may be useful in dysrhythmias due to focal re-entry.

Concealed intraventricular conduction is defined and the following classification of the manifestations of concealed conduction into the bundle branch system is proposed. 1. Trans-septal retrograde concealed intraventricular conduction responsible for (a) perpetuation of functional bundle branch block initiated by a premature supraventriculra impluse; (b) alternation of aberrant ventricular conduction in supraventricular bigeminy; (c) normalization of intraventricular conduction with acceleration or rate in bradycardia-dependent bundle branch block, and (d) prevention of the manifestation of Wenchbach periods of conduction in a bundle branch or fascicle. 2. Antegrade concealed intraventricular conduction responsible for (a) prevention of expected aberrant ventricular conduction when a short cycle follows a long one, and (b) exceptions to the "rule of bigeminy". 3. Retrograde concealed intraventricular conduction of a ventricular escape in association with unidirectional bundle branch or fasciular block responsible for (a) resumption of AV conduction in "paroxysmal AV block" with bundle branch block, and (b) facilitation (due to supernormality) of conduction in type II AV block due to bilateral bundle branch block. 4. Concealed intraventricular conduction of a premature ventricular impulse responsible for (a) initiation or termination of a re-entrant ventricular tachycardia; (b) resetting of an idioventricular pacemaker, and (c) pseudo-intraventricular or pseudo-AV block.

Mechanisms of ventricular tachycardia in patients with chronic recurrent tachycardia and patients with acute myocardial infarction were studied by electrical stimulation of the heart. While re-entry was the most likely mechanism in chronic recurrent ventricular tachycardia, focal activity or re-entry in a very small area seemed to be responsible for ventricular tachycardia during acute myocardial infarction.

An incidence of 60 per cent of postoperative RBBB in the ECG's and available VCG's of 26 patients with isolated muscular VSD repaired was noted after ventriculotomy. In the 38 patients with VSD's near the membranous septum who underwent repair via the tricuspid valve, the incidence of postoperative RBBB was 44 per cent. Results suggested that either ventriculotomy or injury to the right bundle near the VSD can cause RBBB after surgical closure of the defect. Changes in the initial 0.02 second electrovectocardiographic forces in patients with postoperative RBBB were thought to result from central injury to the specialized conduction tissue supplying the interventricular septum. Peripheral RBBB, therefore, could be separated from central RBBB, by the appearance of the initial electrovectorcardiographic forces. For detection of these changes in initial forces, both the ECG recorded at 50 mm. per second and the Frank VCG were useful.

Quinidine gluconate was used to treat arrhythmia induced with maximal exercise testing. Twenty-nine subjects who had previously developed frequent premature contractions on testing were selected for further study. After a control maximal exercise test, quinidine (10 mg. per kilogram) in solution was given orally in a single dose, and two hours later the same test was repeated. Recurrence of premature contractions was completely prevented in five of the 19 subjects tested; suppression was better than the mean value in three others, and in 11 subjects it was below the mean value. The plasma concentration at two hours was 1.68 plus or minus 0.31 ug per milliliter, which is a therapeutic level. Raising the dose to 15 mg. per kilogram eliminated the premautre contractions in six subjects whose response to 10 mg. per kilogram had not been complete, but not in two others. Lowering the dose to 5mg. per kilogram lowered the plasma level to below the therapeutic level. No differences between the responses to the drug of the otherwise healthy subject and those with symptomatic heart disease could be found. Compared with the responses to the control tests, there were small but significant changes in the second test in heart rates, blood pressure, and duration of exercise. Aerobic working capacity estimated by Vo2max was unchanged. Mild toxic effects manifested by malaise and diarrhea were a common finding with both 10mg per kilogram and 15mg per kilogram of quinidine, but not with 5mg per kilogram.

The effects of isoproternol (ISOP) on the functional properties of the A-V conduction system were studied in 16 patients using His-bundle recordings and the atrial extrastimulus technique. In all patients, ISOP at an infusion rate of 1 mcg. per minute resulted in sinus acceleration and enhancement of A-V nodal conduction, but had no effect on His-Purkinje conduction time. ISOP significantly decreased both functional and effective refractory periods of the A-V node. The relative refractory period of the His-Purkinje system decreased by a small amount in five patients in whom the parameter could be compared before and after the drug.

To elucidate the mechanical consequences of ventricular pre-excitation in patients with the W,W syndrome, electrical and mechanical events in the ventricles during anomalous pathway conduction and normal atrioventricular conduction were examined mechanocardiographically in 11 cases of Group A and 19 cases of Group B, in whom anomalous pathway conduction was stopped by procaine amide, resulting in normalization of conduction. Eight healthy persons were employed as a control group. In the control group, procaine amide had no significant effect on the mechanocardiographic values. In the WPW syndrome, significant prolongation of the P-X, P-J, P-T, P-C, P-I, P-Ao, and P-II intervals was induced by the drug. From the results of statistical analyses of measured values, it would appear that mechanical events in the ventricles were accelerated by ventricular pre-excitation but the extent of acceleration of the former was less than the extent of prematurity of the latter. The anomalous ventricular pre-excitation occurred earlier in cases of Group B than in those of Group A, while initiation of ventricular contraction, atrioventricular valve closure, and aortic vlave opening were accelerated more in Group A. In one case of Group B, electrical phenomena could not be related to mechanical events.

Force-velocity curves were constructed in nine patients with CP from a high-fidelity LV pressure tracing and its simultaneously recorded first derivative. Vmax and peak Vce (Vpm) were calculated using the 2-element (Hill) or Voigt model; the curves were also constructed and Vmax measured using the 3-element Maxwell model. The measurements were compared with those in a group of four patients with CMO and with two control subjects. Measurements of the celerity of ventricular contraction--peak LVdp/dt, Max d/IP and Vmax (2-element model)--were reduced in CP and greatly reduced in CMO. The effect of beat-to-beat variations in preload during pulsus paradoxus on the indices of ventricular celerity was studied. Peak LVdp/dt and Vpm varied with the change in LVEDP: the change in Vmax was negligible using the 2-element (Hill) or Voigt model. The 3-element (Maxwell) model failed to discriminate between the three groups of patients and seems to be invalid at high LV end-diastolic pressures.

Dexamethasone exerted no significant hemodynamic effect in sham-operated cats or in cats subjected to acute myocardial ischemia. However, the glucoccortcoid did normalize elevated S-T segments toward pre-ischemic values, and prevented much of the increase in plasma CPK activity following coronary artery ligation. Moreover, dexamethasone prevented loss of CPK activity and restricted the loss of lysosomal hydrolase within ischemic myocardial tissue. These data indicate that lysosomal disruption is an early consequence of myocardial ischemia and that treatment with dexamethasone prevents the loss of myocardial lysosomal and cellular enzymes as reflected in normalization of the ECG and plasma CPK activity of ischemic cats. In this way, dexamethasone may act to retard the spread of the developing infarct within the ischemic myocardium.

In prior studies, we have shown that the antikaliuretic drugs, triamterene and amiloride, through a direct cardiac effect reduce the loss of cardiac potassium induced by the administration of digitalis. Since loss of myocardial potassium is thought to underlie digitalis arrhythmias, this study was performed to determine whether triamterene and amiloride also extend the toxic dose and thus the therapeutic effect of digitalis. In twelve dogs, acetylstrophanthidin was infused (100 ug per minute) serially at 2.5-hour intervals. Trimterene (400 mg. in divided doses) was infused before the third acetylstrophanthidin infusion. This extended the dose required to produce a toxic arrhythmia by 110 per cent. In fourteen additional studies, nine dogs received 400 mg. of triamterene prior to the third acetylstrophanthidin infusion and five animals received 100 mg. of amiloride during the same period. In these fourteen studies, not only was the toxic dose of digitalis extended, but its inotropic effect (see article) (common peak developed isovolumic ventricular pressure) was also increased. These studies have demonstrated that through a cardiac effect, by reducing the digitalis-induced loss of cardiac potassium, the potassium-sparing drugs, triameterene and amiloride, extend the toxic dose of digitalis and thus permit txtension of its inotropic activity.

Four patients, with an additional seven from the literature, had meningitis following a lumbar puncture (LP) that disclosed normal cerebrospinal fluid (CSF). Animal studies demonstrate that perforation of the meninges in the presence of bacteremia enhances the development of meningitis. Simultaneous blood culture should be obtained with all LPs. Regardless of the results of the initial LP, a second CSF examination is recommended in any patient whose clinical condition is deteriorating. If the initial blood culture is positive, a second LP should be strongly considered in all newborn and very young infants.

Suppurative sialadenitis is rare in the neonate and usually involves the parotid glands. Two cases are reported of suppuration of the submandibular gland in the newborn. Diagnosis was made by clinical signs of infection, appearance of a unilateral, erythematous submandibular mass, and expression of pus from the orifice of Wharton duct under the tip of the tongue. Gram stain, culture, and antibiotic sensitivity studies were done on the purulent material. Staphylococcus aureus grew in both cases and was sensitive to treatment with methicillin sodium. This report discusses the management of these cases, with speculation about the possible cause. To my knowledge, these are the only two cases found in the literature of suppurative submandibular sialadenitis occuring as an isolated lesion in the neonatal period.

Three patients with cystic fibrosis were noted to have swelling of knee and ankle joints during exacerbation of their lung disease. Synovial fluid was analyzed in one patient and the synovium underwent biopsy in another. These studies excluded other causes of arthritis but did not contribute any new information on the nature of secondary hypertrophic osteoarthropathy. Radiological examination of long bones confirmed the diagnosis of hypertrophic osteoarthropathy in all three patients. Since many patients with cystic fibrosis survive longer, more instances of hypertrophic osteoarthropathy are expected in the future.

The changes which our health delivery system must undergo in order to respond to the health needs of our society by the year 2000 are presented. The discussion centers on two sets of forces: the necessity for institutionalization and the need for knowledge, information and understanding. Specialization as a means for division of labor among health professionals is predicted to increase.

The provision of primary health care to a rural American Indian population by a pharmacist is discussed. The training and responsibilities of the pharmacist are described. An evaluation of the care provided by the pharmacist to 393 patients is presented.

Seven brands of intravenous fluid administration sets were studied to determine: (1)which set(s) maintained the most consistent flow rates; (2) if the type of fluid container (open, vented or closed, nonvented) affected the flow rates of administration sets; and (3) which set(s) closely approximated the theoretical amounts of fluid to be delivered in one hour at flow rates of 60,100 and 125 ml/hour. Six samples of each brand of administration set were tested in a laboratory setting which approximatedclinical conditions. The type of fluid container had little effect on the performance of the administration sets. The ARDL set was the most accurate in terms of the average volume of fluid delivered in 24 hours. The Burron set required fewer adjustments in 24 hours to maintain a constant flow rate. The U.S. Surgical set recordedthe smallest percent change in flow rate at the end of the first hour. The U.S. Surgical set is rated superior in overall performance. Based on the results of the study,the authors make recommendations to health care personnel, the pharmaceutical industry and the U.S. Pharmacopeial Convention.

The medication error rates of a hospital's multidose and computer-based unit dose drug distribution systems were compared; in addition, the medication error rate of the unit dose system was compared to that reported for noncomputerized unit dose systems in other hospitals. Two similar adult, medical, patient care units, each serviced by a different drug distribution system, were studied for 60 days. Information about the medications administered was obtained by the disguised observation technique during intermittent periods. The observer's notations on the medications administered were compared to the physicians' orders to determine if errors had been committed. Only medication "errors of commission" were recorded. There were significantly fewer medication errors and significantly fewer medications administered at the wrong time in the unit dose system. The medication error rate associated with the unit dose system compared favorably with that of most other unit dose systems. No particular benefit, in terms of the medication error rate, was attributed to the computer element of the unit dose system.

The clinical symptoms and treatment of acute isoniazid toxicity are presented. The use of supportive measures and chemotherapy are discussed in detail. The pharmacology and biochemistry underlying the symptons of isoniazid poisoning are aslo presented. It is concluded that diazepam in combination with pyridoxine is the treatment of choice for the management of convulsions associated with isoniazid toxicity. Pyridoxine should be administered intravenously in amounts equal to the estimated quantity of isoniazid ingested, even if seizures have not occurred.

Federal certificate of need legislation (Section 1122 of Public Law 92-603)aimed at the elimination of costly, duplicative or unneeded health care expenditures is discussed. This law applies only to institutional providers receiving federal reimbursements. The key issues for pharmacy are that proposed substantial changes in service and capital expenditures of $100,000 or more must be justified to local and state comprehensive planning agencies prior to implentation. Failure to comply with the legislation can result in a reduction or withholding of federal reimbursement.

A simplified method for the quantitative analysis of hyoscyamine hydrobromide or atropine in Belladonna Tincture USP is described. The procedure is based on the formation of an alkaloid-dye complex which can be extracted with an organic solvent and measured spectrophotometrically. The results obtained by this method compare favorably with those obtained by the USP method.

Recommendations regarding (1)hospital receipt and storage of large-volume parenterals and (2)hospital compounding of intravenous admixtures are presented. The recommendations are presented in a stepwise manner, and a self-evaluation form is included. Also included is a pictorial illustration of a suggested dressing change for an i.v.catheter.

The basic concepts of quality assurance are discussed as they apply to hospital pharmacy practice. The terms norm, criteria, standard, structure assessment,process assessment, and outcome assement are defined. The interrelationships among the following five steps in the quality assurance cycle are reviewed: definition of quality, quality assessment, education and change, redefinition of quality, and reassessment of quality. Finally, the importance of research in the quality assurance process is discussed.

The relationship between adherence to approved drug labeling and patient length of stay in hospitals was studied. The records of 200 patients at a 175-bed, short-term, pediatric hospital were reviewed to determine if the actual drug therapy agreed with the officially approved indications, contraindications, age restrictions and dosages. The average length of patient stay was nine days. Only 19% of the observed variation in length of stay could be correlated to the number of doses per drug per patient. The variable dose, indications, contraindications and age agreement could not be correlated to length of stay.

A program designed to improve patient care by assuring the quality of medications stored in patient care areas is described. A questionnaire covering six major areas--medication room, controlled substances, refrigerator, emergency medication kit, other storage areas and miscellaneous--designed to assist in gathering information during medication quality assurance rounds was developed. Rounds are conducted every four months by a pharmacist and a nurse. To ensure that any deficiencies are corrected, copies of the findings are sent to the appropriate pharmacy and nursing personnel.

A 23-bed hospital unit specializing in rehabilitating patients suffering from chronic pain by (1) reducing their consumption of and dependence on medication, (2) increasing their level of daily activity and (3) discouraging pain-oriented behavior is described. In addition to aspirin or acetaminophen, four drugs--amitriptyline, diphenylhydantoin, cobra venom extract and methadone--are used to reduce pain while other therapeutic measures are used to rehabilitate the patients. Methods for reducing the amount of analgesics taken by chronic pain patients are discussed. Unit dose packaging is used because the oral solid dosage forms (including placebos) are made to look alike.

A study was conducted to determine if ice cream and sherbet interfered with the adsorption of aspirin onto activated charcoal both in vivo and in vitro. An aqueous suspension of 20 g activated charcoal decreased the absorption of 1 g aspirin by 65%; the same dose of activated charcoal with 50 g of ice cream reduced aspirin absorption by only 42% under otherwise identical conditions. In vitro tests showed that different ice creams and sherbet decrease the adsoprtion of aspirin onto activated charcoal. Thus, although ice cream is useful for preparing palatable suspensions of activated charcoal, it decreases appreciably the antidotal efficacy of the adsorbent.

The gentamicin blood level vs. time profiles of various dosage regimens recommended for renal impairment were reassessed by applying pharmacokinetic techniques to the patient data in the clinical literature. Eight dosage regimen modifications were tested in eight prototype cases of renal impairment (serum creatinine range of 0.9-12.0 mg/100 ml and creatinine clearance range of 5-100 ml/min/1.73 m-2) using simulated blood level vs. time profiles generated from the known pharmacokinetic parameters for gentamicin. Employing a one-hour intravenous infusion at dosages and dosing intervals recommended by the various blood level vs. time profiles. Methods recommending shorter dosing intervals (every 24 hours and less) generally resulted in a greater percent duration of the dosing interval above the selected "effective response concentration" (ERC) of a 4mug/ml blood level and a markedly shorter duration of sub-ERC blood levels. Methods based on creatinine clearance as an index of renal function generally achieved greater percent duration of the dosing interval above the ERC and lesser duration of blood levels below this value than methods based on serum creatinine.

The use of diuretics to treat edema is reviewed. Normal salt and water metabolism is reviewed briefly. The drugs covered are the thiazide diuretics, loop diuretics(ethacrynic acid and furosemide) and distal blocking agents (spironolactone and triamterene). The sites and modes of action, indications, doses, complications and relative costs of these agents are discussed.

d-Isoproterenol (ISO) applied topically to the rabbit eye specifically lowered intraocular pressure. Thus, it effectively reduced normal intraocular pressure and inhibited intraocular pressure elevation induced by water load without causing other obvious local or systemic pharmacologic effects. By comparison, dl-ISO was pharmacologically nonspecific in that amounts required to reduce intraocular pressure also produced significant and marked tachycardia. Furthermore, maximal intraocular pressure reduction was less with dl-than with d-ISO. Accordingly, and in consideration of reported clinical experience with dl-ISO in glaucomatous man, the d-isomer should be the preferred form of ISO for treating glaucoma. d-ISO should offer advantages over any other topical medication used currently in the treatment of this condition. Toxicity studies employing large, topical doses of drug in rabbit eyes showed that d-ISO was free from ocular irritation as well as systemic toxicologic effects and should be safe for controlled studies in man.

Visual acuity, color vision, pupillary reaction, induced Pulfrich phenomenon, kinetic fields, static fields, afterimage testing, and ophthalmoscopic evaluation were studied in nine patients with a history of retrobulbar neuritis. The most consistently reliable test for determining the presence of an old optic nerve defect in these patients was meridional 0 to 180 degrees static perimetry. There was a uniform decrease in brightness discrimination to either side of the foveal peak.

Ligneous conjunctivitis occurred unilaterally in a 74-year-old man after pterygium excision and only involved the bulbar conjunctiva. Histochemical studies confirmed the presence of mucopolysaccharides in the lesion sensitive to hyaluronidase. The patient was treated successfully with topical hyaluronidase and alpha-chymotrypsin, with no recurrence 20 months after cessation of therapy.

We used the head-tilt test--based on an imbalance between the function of a paretic superior oblique muscle and its homonymous superior rectus muscle, rather than on an anomaly of cycloversion-to test three patients with superior oblique muscle palsies. Spontaneous ocular torticollis was absent if a patient had poor vision in one eye or if his vertical fusional amplitudes were of such magnitude that he was able to overcome his vertical deviation in all positions of gaze. These latter instances, though rare, may be more common than reports indicate.

We made 344 stereoacuity determinations (Titmus Stereotest) on 321 children, ages 1 1/2 to 13 years, who had normal binocular single vision tested by other factors. The data showed a gradual improvement in stereoacuity scores with increasing age--up to age 9--when a normal stereoacuity of 40 seconds of arc was consistently found. The lower limits of stereoacuity compatible with normal binocular single vision were 3 1/2 years, 3,000 seconds; 5 years, 140 seconds: 5 1/2 years, 100 seconds; 6 years, 80 seconds; 7 years, 60 seconds; and 9 years, 40 seconds.

Genetic parameters were contrasted for vergence amplitudes within three populations--esotropic, exotropic, and randomly selected populations-who differed in their incidence of subtypes of strabismus. In general, heritabilities for convergence exceeded those for divergence, and heritabilities for recovery points exceeded those for break points. Heritability estimates for diveregence amplitudes were significantly different for the random and esotropia populations, while convergence heritability estimates for these groups were similar. Thus, gene differences influencing divergence ability contributed to genetic variance for strabismus.

We examined 21 patients with closed-head trauma and resulting paralysis of the lateral rectus muscle. Clinical findings included laterally directed gaze palsy, some unconsciousness, and pseudo-duane's phenomenon suggesting a supranuclear lesion at the level of the upper pontine tegmentum, and pontine paramedial reticular formation. The surgical procedure of choice was a "midline operation," that is, the appropriate number of millimeters of recession and resection to achieve 0 to 5 degrees of exotropia in the primary position of gaze. Frequently, the medial rectus muscle must be recessed 10 nm or more and the lateral rectus muscle resected 10 nm or more to achieve this result. None of the 21 patients had diplopia after the midline procedure.

Studies of corneal explants in the hamster cheek pouch chamber have demonstrated that blood vessels invade the cornea only if the tissue is first infiltrated by leukocytes. In view of this observation, a comparative study of the events that precede and accompany corneal vascularization was undertaken in various experimental models. A variety of established methods were used to induce corneal vascularization, including exposure of the cornea to noxious agents, intracorneal injection of antigens into sensitized animals, as well as maintaining animals on diets deficient in vitamin A or riboflavin. In all models studied, the corneal vascularization was a manifestation of the reparative phase of the inflammatory response. A conspicuous leukocytic infiltrate of the cornea preceded and accompanied the corneal vascularization in all of the models. Although the lesions varied in several respects in the different models, all models displayed three phases with regard to vascularization: an early prevascular phase of leukocytic infiltration, a second phase where blood vessels persisted in the cornea in the absence of leukocytes. The latent period that preceded vascularization was directly related to the time of the initial leukocytic infiltration. The models in which a delay occurred in the leukocytic invasion displayed a subsequent delay in the vascular ingrowth. Conversely, in experiments where there was a rapid and extensive leukocytic invasion, there was also an early and enhanced corneal vasoproliferative response. In the various modesl investigated, the sites of the leukocytic infiltration and subsequent vascular ingrowth into the cornea paralleled each other. The data further support the hypotheses that leukocytes are a prerequisite to corneal vascularization and that leukocytes produce one or more factors which stimulate directional vascular growth.

The brains of 18 patients were examined post mortem for histologic criteria of edema, and samples of white and gray matter were analyzed for water, sodium, and potassium content. In a parallel experimental study, brains of cats with unilateral freezing lesions and resulting cerebral edema were similarly examined immediately after death and up to 18 hours post mortem. In both types of material, in gray matter there was a relatively rapid (within less than 4 hours) increase in water and sodium content and fall in potassium content. In normal and edematous white matter, little change was observed post mortem. No correlation could be demonstrated in any of the material studied between water content and histologic grading for cerebral edema. It is concluded that determination of water content in the white matter postmortem could be a useful tool for the neuropathologist. Histologic assessment of cerebral edema is of little value.

Administration to rats of D-galactosamine (400 mg/kg) produces liver cell death that develops during the first 24 hours. Plasma membranes isolated within the first few hours from these animals show a 40% reduction in 5'-nucleotidase activity and a two-fold increase in maximum negative ellipticity determined by circular dichroism. Simultaneous administration of uridine prevents liver cell death and these early alterations in the plasma membranes. Uridine also prevents cell death if administered for up to 3 hours after galactosamine. The 5'nucleotidase activity reduced when uridine is administered for up to 2-1/2 hours after galactosamine. Changes in the liver calcium ion concentration accompany these plasma membrane alterations. Uridine will prevent and reverse the changes in calcium content in parallel to its ability to reverse the membrane alterations. The significance of these findings with respect to the mechanism of galactosamine-induced liver cell death is discussed.

The effects of ischemia, induced by a tourniquet, were investigated on 36 adult Holtzman female rates in terms of damage to the ventral horn cell of the spinal cord and tibial nerve and motor end-plate degeneration and regeneration. Clinically, the rats were tested for sensory and motor loss and recovery and these results were compared with the histological findings. Ischemic periods of 2, 4, 6, and 8 hours were used followed by survival times of 3 weeks to 9 months. Histologically, there was degeneration and regeneration found to varying degrees in the nerve and motor end-plate. There were no changes found in the ventral horn cell. There was a loss of pain sensation in all animals, except the 2 hour group, and a loss of motor function. Motor function, preceded by sensation, returned in all animals. With the absence of ventral horn cell damage it was not surprising to find adequate regeneration histologically and, therefore, a return of both sensory and motor function.

The purpose of the study was to study the effects of cross-transfer on fractionated reaction time components in the unilateral and bilateral measurement conditions. Ss (N = 30) responded to a sudden arm displacement from an electromagnet by abducting the falling arm (unilateral ipsilateral trial, N = 15), by abducting the non-stimulus limb from a RT switch (unilateral contralateral trial, N = 15), or by performing both of these responses simultaneously (bilateral trial, N = 15). EMGs from the 45 randomized trials were monitored from the middle portions of the relaxed deltoideus muscles. Dependent variables were ipsilateral reflex latency (IRL), ipsilateral premotor time (IPMT), contralateral premotor time (CPMT), and contralateral reaction time (CRT). The following statistical procedures were applied to the data: an interclass correlation, a subjects-by-trials analysis of trends for each variable, and a single-groups subjects by two within-group variables analysis of variance for the six logical comparisons. IPMT was the only latency decreased by the addition of the bilateral measurement condition; however IPMT remained slower than CPMT even in the bilateral measurement condition. IRLs, CPMTs, and CRTs remained the same. The addition of a bilateral measurement condition appeared to result in less delay from the synchronous reflex volley to IPMT than in the unilateral measurement condition.

The authors describe their experience with the different types of telemetry systems, applicable for locomotion studies and other similar areas of research. They describe the differences between frequency modulation (FM) systems and time-domain multiplexing (PAM) systems. They discuss the advantages and the disadvantages of each of these systems, particularly as applied to the transmission of EMG signals.

The authors discuss their observations of acute psychiatric patients in a day hospital, noting the universality of the existential concerns that arise once the patient has confronted his illness. They discuss the problem of what determins a "cure" in emotional disturbances and suggest that the primary issue is for patients to learn to live as healthy people within the limits of their individual potential.

The coverage of out-of-hospital expenses for mental health care through prepayment and insurance programs has been a major advance in removing the economic barriers to early detection, diagnosis, and treatment of mental disorders. However, obstacles to obtaining treatment block many eligible people from receiving help. The authors conducted a study among members of the United Auto Workers union to identify these roadblocks. Among the obstacles were differences in perceptions of need for treatment and in attitudes toward treatment, and lack of awareness of eligibility for benefits among three key groups - consumers, referral agents, and providers. The authors urge psychiatry to help in removing these obstacles.

The use of the diagnosis "sociopathy" and its synonyms hinders the search for other kinds of symptomatology, the recognition of which might lead to appropriate therapeutic intervention. The authors therefore suggest that the terms "sociopathic personality," "antisocial personality," and "acting out aggressive reaction of childhood or adolescence" be eliminated as primary diagnoses from the psychiatric nomenclature for children or adolescents. Two case reports are presented to emphasize the damage these diagnoses can cause.

Drawing on their experience, the authors explore the opportunity for learning administrative process that is available to the psychiatric chief resident. They categorize six models of the psychiatric chief residency and document two of them, the ward chief and the interface chief, as providing particularly rich administrative experiences. Although the chief resident's administrative experience is only a preliminary one, it can be a first step in solidifying his identity as a clinician-executive.

The authors present data from a survey of four methadone maintenance programs, five outpatient clinics, six nonresidential facilities, and nine therapeutic communities affiliated with the Dade County Comprehensive Drug Program. The treatment population included more blacks but fewer Latins than the general county population. Primary drugs of abuse were narcotics in methadone clinics and "softer" drugs in outpatient and nonresidential facilities. Most patients were either self- or court referrals. Direct per patient costs, which were lowest in the outpatient clinics, averaged $1,041. The authors suggest that their data may aid other comprehensive drug treatment programs in establishing guidelines.

The authors examined 88 patients with an admission diagnosis of schizophrenia for the presence of good and poor clinical prognostic signs and related their findings to the clinical presentation, response to somatic treatments, and prevalence of illness in first-degree relatives. The results augment the growing evidence that good and poor prognosis schizophrenia are different illnesses and that good prognosis schizophrenia is frequently indistinguishable from manic-depressive illness.

The authors report the occurrence of a sever striopallidal disorder in a schizophrenic patient one week after he received fluphenazine enanthate injections on an every-other-day schedule. In view of current interest in depot psychopharmaceuticals, they recommend that careful attention be given to dosage and administration schedules and to the possibility of delayed pseudoparkinsonian symptoms. Emergency room physicians should be alerted to the possible side effects of such drugs.

The author describes a technique for use with adolescents (perferably nonpsychotic, acting-out patients) in the terminal phase of psychiatric hospitalization. Patient, parents, and therapist have a summit meeting during which they write a contract which is a prerequisite of the patient's discharge. The document, which all parties sign, specifies conditions of the patient's return to family life. A case report, including a contract, illustrates the use of the technique.

The author presents data on the Minnesota Multiphasic Personality Inventory (MMPI) characteristics of a sample of enlisted Army men returning from Viet Nam identified as heroin abusers. Although a marked heterogeneity of MMPI profile types was found, a significant percentage of the subjects showed indications of marked psychopathology, and only a minority performed within normal limits on the MMPI. Theses military subjects showed neither greater nor less psychopathology and sociopathology than previously reported samples of civilian addicts.

Although traditional societies in Oceania direct their fertility choice behavior (if any) toward spirits rather than sexual intercourse, closer observation shows that these fertility choice behaviors, while groping and magical, sometimes have empirical value. The author notes that the alternative to effective fertility control in these societies has sometimes been population regulation of the Malthusian variety (e.g., murder and starvation). Efforts aimed at spacing the family in a less savage and more effective manner deserve encouragement, the author believes.

The wacinko syndrome in the Oglala Sioux varies from a nonclinical reaction to pathological degrees of anger, pouting, withdrawal, depression, psychomotor retardation, mutism, immobility, and even to suicide. Although indigenous proctitioners recognize the syndrome as a distinctive disorder, it has not been described by non-Indian practitioners. The author presents a case report and suggests that most cases are diagnosable as reactive depressive illness.

The thalamoperforating arteries are divided into 2 distinct groups, an anterior and a posterior. The PTPAS are retromammillary branches of the precommunicating segments of the posterior cerebral arteries. The PTPAS may be divided into interpeduncular, mesencephalic and thalamic segments and are not directly related to the third ventricle. They are primarily midbrain and thalamic arteries. The main trunk of the PTPA (mesencephalic segment) normally does not undulate, but assumes a characteristically straight configuration. The ATPAS arise from the posterior communicating arteries anterior and lateral to the mamillary bodies. The ATPAS are primarily diencephalic vessels. Interpeduncular, paraventricular (hypothalamic) and thalamic segments may be identified. The major segment of the ATPAS is para third ventricular in location at the level of the massa intermedia.

The tomographic findings in the Stenvers' projection of inner ears of 24 patients with Waardenburg's syndrome are described. In 12 of these 48 inner ears deafness was found. The roentgenographic examination did not show any malformation of the inner ears of these patients. In the literature on this subject, the tomographic findings of the inner ears of 12 deaf patients with Waardenburg's syndrome have been described. In 8 of them malformations were reported, especially of the semicircular canals. These findings in the literature could not be confirmed by our study.

In the present case, a patient with symptoms referable to the occipital lobe, selective angiography demonstrated evidence of occlusion of branches of the left posterior cerebral artery with collateral circulation in addition to the congenital anomaly. The congenital absence of both vertebral arteries with a large occipital-basilar anastomosis may be explained by our hypothesis that occlusion occurred at the gestation age of 32-36 days. This case is presented in the hope that it will lead to the recognition of similar anomalies and further support our hypothesis. Selective angiography is the method of choice in the study of cerebrovascular disease and brachiocephalic vessels.

Sixty-five B-mode carotid sonograms were obtained at random on patients undergoing cerebral arteriography. A 5 mHz transducer was used. The results were correlated with magnified cervical carotid arteriograms obtained on these patients. B-mode sonography was accurate in evaluating the carotid arteries for surgical stenosis in 72 per cent of the cases. The feasibility of using B-mode sonography as a screening test in patients with asymptomatic carotid bruits is discussed.

The efficacy of hypnotherapy in aborting acute asthmatic attacks was studied in 17 children ranging in age from six to 17. All had as their primary diagnosis bronchial asthma. Prior to hypnotic induction pulmonary function was assessed, then monitored in the immediate post hypnotic period and at two intervals thereafter. The average improvement for all subjects was greater than 50% above the baseline measurement as documented by spirometry, monitored dyspnea, wheezing and subjective ratings by the subjects. It is suggested that hypnotherapy may be an important tool in ameliorating asthma, improving ventilatory capacity and promoting relaxation without recourse to pharmacologic agents. One explanation offered is that hypnosis affects an automic response, thereby diminishing bronchospasm.

1728 patients prick skin tested for eight fungi in the St. Louis, Missouri metropolitan area exhibited overall a rather low level of allergenicity as well as a general lack of cross-reactivity. Alternaria, however, elicited a high allergic reaction in both reactivity level and reaction frequency in the population. Response of pediatric patients was higher than that of adults, and the extract concentration and source varied the allergenic response only slightly.

An evaluation was made of the protection induced by an attenuated Anaplasma marginale vaccine in young purebred cattle against the challenge exposure of naturally transmitted anaplasmosis in enzootic areas of Mexico. The cattle, which were raised in isolation units free of arthropods, consisted of 10 Brown Swiss calves (1 to 13 months of age) and 8 Holstein calves (5 to 7 months of age). They were paired by breed, age, and body weight, and allotted to 2 equal groups. Calves in 1 group were vaccinated, and at 6 weeks after vaccinations were done, calves in both groups were placed in the field where they were raised for approximately 1 year. Two Holstein and 3 Brown Swiss calves of the nonvaccinated group (group 2) developed clinical anaplasmosis, and the remaining calves of this group had hematologic evidence of the disease during the 2 to 4 months after introduction to the field. The vaccinated group, which remained free of anaplasmosis, showed consistently greater weight gain than did the controls. Among the Holstein calves, the maximum weight difference in favor of the vaccinated group was 50 kg/head at 5.5 months after field exposure, and among the Brown Swiss calves, the differences in weight gain in favor of vaccinated calves at the end of the 12-month period was between 11 and 30 percent. It is concluded that the vaccine provided a means for safe adaptation of high-quality young cattle to the tropics by protecting them against what appears to be the major obstacle to this practice, anaplasmosis.

Physiologic responses of irradiated and nonirradiated Shetland Ponies to controlled exercise were measured over a period of 5 years. The 5-year test began when the ponies were 3 years old and 5 months after they were exposed to 650 R of 60-Co gamma radiation. Significant differences in heart rates, respiratory rates, and rectal temperatures were demonstrated between irradiated and nonirradiated ponies when subjected to exercise and high ambient temperatures. Inthe irradiated group, heart rates were usually slower, especially during recovery immediately after exercise, and respiratory rates and rectal temperatures were higher than these rates were in the nonirradiated group when exercising in ambient temperature of 29.5 C. Exhaustive exercise did not amplify any of the differences which were apparent with moderate exercise. From a general viewpoint, the irradiated ponies performed work as efficiently as did the nonirradiated ponies. Early changes in blood-cell concentrations after irradiation were similar to those which have been observed in other large animal species. Time required for the various types of blood cells to return to base line values ranged between 3 months and 3 years.

Surgically placed bile duct cannulas allowed collection of secreted bile from nonanesthetized ponies. UNINTERRUPTED ENTEROPHEPATIC CIRCULATION WAS PERMITTED BETWEEN COLLECTIONS. Deleterious effects of cannulation were not observed. Average bile flow was 18.6 plus or minus 1.72 (standard error) mul/minute/kg, bile acid excretion was 0.179 plus or minus 0.0212 mumole/minute/kg, and bilirubin excretion averaged 1.22 plus or minus 0.136 mug/minute/kg.

Tetracycline-labeled bones of 23 foals from 52 to 104 days old were sectioned and macroscopically examined to assess the extent of ossification or fusion of ossification centers. A grading system was devised with which to record information about the ossification centers and growth plates. The objective was to define anatomic standards which could contribute toward obtaining an accurate radiologic interpretation. Labeled limb bones of 3 neonatal foals were similarly treated, but grading of these was limited to the consideration of whether each site was still cartilaginous or had commenced to ossify.

Glossitis, known clinically as "redtongue," was studied in tissues from 34 military working dogs (MWD) in the Republic of Vietnam. This condition was manifested grossly by loss of lingual papillae on the dorsal margins of the rostral third of the tongue. Microscopically, the principal lesions consisted of loss of filiform papillae, hemorrhage and edema in the lamina propria, acanthosis, and cellular infiltration. The cause of glossitis remains unknown at this time.

A cystic condition of the peritoneum of tuna fish (Thunnus thynnus) caught from the Persian Gulf is described. Parasitologic examination established widespread infection by the cestode Grillotia. An account is given of the taxonomic position of this genus.