Magnetic susceptibility measurement using a double-DANTE tagging (DDT) sequence

Preliminary results are presented for the nuclear magnetic resonance (NMR) measurement of field gradients generated by differences in magnetic susceptibility. The DDT technique maps the resonant frequency throughout the sample in a single image. Regions of paramagnetic and diamagnetic susceptibility are differentiated with a single magnitude-calculated image.

Evaluation of treatment protocols on minimal to moderate spasticity in multiple sclerosis

Thirty men and women diagnosed with definite multiple sclerosis (MS) were treated for ten weeks in a blinded, cross-over study. Patients with minimal to moderate spasticity were randomized to one of three sequences to evaluate the effects on MS-related spasticity of baclofen alone, stretching regimen with placebo, placebo alone, and stretching regimen with baclofen. The Cybex II isokinetic unit, timed gait, Ashworth scale, and subject's assessment of function were objective and subjective measures used to evaluate changes in hypertonicity. There was significant correlation between the Cybex and Ashworth as methods of measuring spasticity. Overall, treatment with baclofen alone significantly improved moderate quadriceps spasticity as measured by Cybex flexion scores. A trend, indicative of enhancing the beneficial effects of baclofen, was noted when stretching exercises were added to the treatment.

Rates of various reactions catalyzed by ATP synthase as related to the mechanism of ATP synthesis

The forward and reverse rates of the overall reaction catalyzed by the ATP synthase in intact rat heart mitochondria, as measured with 32P, were compared with the rates of two partial steps, as measured with 18O. Such rates have been measured previously, but their relationship to one another has not been determined, nor have the partial reactions been measured in intact mitochondria. The partial steps measured were the rate of medium Pi formation from bound ATP (in state 4 this also equals the rate of medium Pi into bound ATP) and the rate of formation of bound ATP from bound Pi within the catalytic site. The rates of both partial reactions can be measured by 31P NMR analysis of the 18O distribution in Pi and ATP released from the enzyme during incubation of intact mitochondria with highly labeled [18O]Pi. Data were obtained in state 3 and 4 conditions with variation in substrate concentrations, temperature, and mitochondrial membrane electrical potential gradient (delta psi m). Although neither binding nor release of ATP is necessary for phosphate/H2O exchange, in state 4 the rate of incorporation of at least one water oxygen atom into phosphate is approximately twice the rate of the overall reaction rate under a variety of conditions. This can be explained if the release of Pi or ATP at one catalytic site does not occur, unless ATP or Pi is bound at another catalytic site. Such coupling provides strong support for the previously proposed alternating site mechanism. In state 3 slow reversal of ATP synthesis occurs within the mitochondrial matrix and can be detected as incorporation of water oxygen atoms into medium Pi even though medium [32P]ATP does not give rise to 32Pi in state 3. These data can be explained by lack of translocation of ATP from the medium to the mitochondrial matrix. The rate of bound ATP formation from bound Pi at catalytic sites was over twice the rate of the overall reaction in both states 4 and 3. The rate of reaction at the catalytic site is considerably less sensitive to the decrease in membrane potential and the concentration of medium ADP than is the rate of medium ATP formation. This supports the view that the active catalytic site is occluded and proceeds at a rapid rate which is relatively independent of delta psi m and of media substrates.

Intraoperative colonic lavage: failure to decrease mucosal microflora

Few data exist concerning the ability of intraoperative colonic lavage to decrease colonic bacterial counts, and nothing is known about its effect on the recently described mucosa-associated bacteria. The goal of our study was to determine the impact of intraoperative colonic lavage on both the intraluminal and mucosal microflora. After intraoperative colonic washout in 10 adult male Sprague-Dawley rats, quantitative and qualitative aerobic and anaerobic cultures of the intraluminal and mucosal bacteria were obtained. Tissue was also removed for scanning electron microscopic examination of the colon wall. Whereas 1000-fold to 10,000-fold reductions of aerobic and anaerobic intraluminal flora were achieved with mechanical lavage, reductions of aerobic or anaerobic mucosal bacteria were not significant. Failure to diminish bacterial colonization in this ecologic niche may be partly responsible for the persistently high infection rate after emergency colorectal surgery.

Suppression of the human mucosal-related colonic microflora with prophylactic parenteral and/or oral antibiotics

The purpose of this investigation was to assess the effects of preoperative administration of parenteral antibiotics with or without concomitant preoperative administration of oral antibiotics on the colonic mucosal-related microflora. Thirty-one patients were studied in a prospective fashion. Group A patients (n = 8) had colonoscopic mucosal biopsies performed after mechanical bowel preparation. Group B patients (n = 5) received neomycin and erythromycin (NE), 1 g each following mechanical bowel preparation, at 1, 2, and 11 p.m. the evening prior to either elective colon resection (n = 2) or prior to colonoscopic biopsy (n = 3). Emergent trauma patients who had left colon or sigmoid perforations due to gunshot wounds requiring segmental resection comprised group C (n = 7). These patients received cefoxitin or cefotetan 2 g intravenously preoperatively. Individuals in group D (n = 11) all had elective left hemicolectomies or sigmoid resections due to nonobstructing malignancies. These patients underwent the same regimen as group B patients in addition to receiving intravenous cefoxitin perioperatively. Quantitative and qualitative bacterial cultures as well as scanning electron microscopy (SEM) were used to study the mucosa-associated flora. Tissue for culture and SEM were obtained from the pathologic specimen immediately after removal. The interval between the dosage of parenteral antibiotics to tissue removal was 3 hours in both groups. Anaerobic and aerobic counts were suppressed the greatest in patients receiving both oral and parenteral antibiotics (p = 0.0001). Mean anaerobic counts decreased from 3.4 X 10(7) in group A to 1.8 X 10(2) (mean cfu/g) in group D patients. Mean aerobic counts in group A decreased from 3.7 X 10(6) to 64 (mean cfu/g) in group D.(ABSTRACT TRUNCATED AT 250 WORDS)

A DANTE tagging sequence for the evaluation of translational sample motion

A magnetic resonance imaging sequence that is sensitive to translational motion such as that seen with cardiac contraction is presented. The sequence employs DANTE radio-frequency excitation with a continuous magnetic field gradient to generate a grid pattern of lines. There is improved line resolution and reduced eddy-current formation over current techniques.

Assessing the risk of kernicterus using nuclear magnetic resonance

Kernicterus is the end result of injury to the central nervous system by bilirubin and other factors. Serum bilirubin levels alone are poor predictors of kernicterus especially in sick preterm infants. We need a rapid noninvasive indicator of neurotoxicity and impending cell injury. Bilirubin first seems to affect neuronal conduction before energy metabolism is impaired. Unchecked, this may lead to failure of ATP synthesis, resulting in the breakdown of all active intracellular processes. It is now possible to measure energy metabolism in vivo and noninvasively by surface coil 31P NMR spectroscopy. Recent animal studies demonstrate perturbations in energy metabolism when hyperbilirubinemia is associated with an open BBB. Perhaps the further developments in NMR spectroscopy and imaging will permit regional assessment of impending or actual bilirubin neurotoxicity and allow us to identify those infants in need of immediate treatment.

Another complication of intravenous catheterization: a case report

The list of possible complications following central vein catheterization has been well described. A technique for placement of a catheter into a central vein has to be learned by the individual following guidelines dictated by anatomical understanding, literature reporting, and other practitioners' previous experience. We report here another complication of intravenous catheterization where the first catheter is severed completely by a second, larger needle.

Nursing Model Encourages Care Planning

After examining the pitfalls of nursing care plans done in a medical model format, a system based entirely on the nursing model was developed in a 500-bed acute care hospital. By centering the format, the structure, and the education around the patient problems treated by nurses, the nurses in this hospital began to do care plans for the purpose of improving patient care rather than for compliance with the Joint Commission on Accreditation of Healthcare Organizations' regulations. The system has led to more knowledgeable nurses and a more autonomous and rewarding practice setting.

Comparison of propofol and midazolam for sedation in critically ill patients

101 critically ill patients admitted to five intensive-care units were allocated randomly to receive a continuous intravenous infusion of either propofol or midazolam for sedation for up to 24 h. In addition, morphine was given to provide analgesia. The mean duration of infusion was 20.2 h (range 3.0-24.5) in the propofol group and 21.3 h (4.0-47.0) in the midazolam group and infusion rates were 1.77 mg/kg/h (range 0.40-5.00) and 0.10 mg/kg/h (0.01-0.26), respectively. The infusion rates were adjusted as necessary, and the desired level of sedation was achieved easily in most patients in both groups. There were slight falls in arterial pressure, but there were no significant differences between the groups. Heart rate was lower in patients who received propofol. Some small changes occurred in biochemical and haematological variables in both groups, but they were not clinically significant. There was no indication that either drug substantially impaired adrenal steroidogenesis. When the infusion was discontinued, there was less variability in recovery of consciousness in patients who had received propofol. In a subgroup of patients, weaning from mechanical ventilation was achieved significantly faster after discontinuation of propofol than of midazolam. Propofol proved to be a satisfactory agent for sedation of these critically ill patients and compared favourably with midazolam.

Mycetoma of the hand

Mycetoma or maduromycosis is a rare chronic granulomatous disease caused by a fungus infection. We report a rare case of mycetoma in the hand; to our knowledge this is the first report in the United States of mycetoma caused by Nocardia asteroides. The patient had had 2 years of chronic drainage and edema of the left hand after a penetrating injury sustained in the shipyards. After surgical debridement he was treated with co-triamazole, 1 tablet orally four times a day for 6 months. The chronic drainage has ceased but most of his wrist and hand joint movements are restricted.

Anaphylactoid reaction to chymopapain

Chymopapain is a proteolytic enzyme used in the chemonucleolysis of the herniated nucleus pulposus of lumbar intervertebral discs. It causes rapid hydrolysis of the noncollagenous polypeptides that maintain the tertiary structure of the chondromucoprotein of the nucleus pulposus. We report here an anaphylactoid reaction after the intervertebral injection of chymopapain.

Differentiation and treatment of hemangiomas and arteriovenous malformations

Confusion exists about the differentiation of hemangiomas and other congenital vascular anomalies although they are the most common type of birth defect. During the past 10 years, these lesions have been reclassified on a pathophysiological basis which assists in defining their prognosis and treatment. Hemangiomas are broken down into three categories, those which affect the afferent capillary bed and may involute, efferent venous or lymphatic lesions which grow with the patient, and progressively growing vascular hamartomas which affect both venous and arterial limbs of the circulation and may threaten with limb loss or congestive heart failure. The afferent-efferent lesions require a multidisciplinary approach with close follow-up for their successful management.

A path analysis of an adolescent drinking behavior model derived from problem behavior theory

The interrelationships between composite variables comprised of demographics, socialization, personality, perceived environment, conventional and problem behaviors, and their combined mediational influences on adolescent drinking behavior are examined. Students randomly sampled from four suburban, metropolitan-area high schools (N = 499) were administered the 250-question Survey of Underage Drinking Styles. All 12 composite variables, derived from the survey, were arranged in a causal model and submitted to a confirmatory path analysis. Data were analyzed by multiple regression procedures. According to the present model, a powerful pathway through to drinking may begin with family interaction problems, which may lead to a reduction in the adolescent's social coping skills. A reduction in the adolescent's coping skills may lead to a compensatory belief that alcohol improves mental and physical functions and an increased affiliation with and acceptance of the peer group's attitude and behavior toward consuming alcohol as a replacement coping skill. The adolescent's drinking may then increase as a result of the affiliative need to conform to peer group pressure.

Cerebral blood flow measured by NMR indicator dilution in cats

We developed techniques to assess the utility of a nuclear magnetic resonance (NMR) indicator for cerebral blood flow studies in cats, using Freon-22 for the first candidate. A PIN-diode-switched NMR experiment allowed the acquisition of an arterial as well as a cerebral fluorine-19 signal proportional to concentration vs. time in a 1.89 T magnet. Mean +/- SD blood:brain partition coefficients for Freon-22 were estimated at 0.93 +/- 0.08 for gray matter and 0.77 +/- 0.12 for white matter. Using maximum-likelihood curve fitting, estimates of mean +/- SD resting cerebral blood flow were 50 +/- 19 ml/100 g-min for gray matter and 5.0 +/- 2.0 ml/100 g-min for white matter. Hypercapnia produced the expected increases in gray and white matter blood flow. The physiologic effects of Freon-22, including an increase in cerebral blood flow itself with administration of 40% by volume, may limit its use as an indicator. Nevertheless, the NMR techniques described demonstrate the feasibility of fluorine-19-labeled compounds as cerebral blood flow indicators and the promise for their use in humans.

Chest wall mesenchymoma (hamartoma) in infancy. CT and MR findings

A case of a chest wall mesenchymoma in a five month old infant is presented, and the role of CT and MR are emphasized. There have been no prior reports of the CT or MR findings in this entity.

In vivo functioning of creatine phosphokinase in human forearm muscle, studied by 31P NMR saturation transfer

31P nuclear magnetic resonance (NMR) saturation transfer has been used to measure enzymatic flux through the creatine phosphokinase reaction in the direction of ATP synthesis in the human forearm muscle flexor digitorum superficialis. Modification of the ratio method for measurement of spin-lattice relaxation (R. Freeman, H.D.W. Hill, and R. Kaptein, J. Magn. Reson. 7, 82(1972]was tested and used to appreciably shorten the duration of the measurement. Under conditions of steady state work intracellular pH decreased slightly by 0.06 units and the spin-lattice relaxation time of phosphocreatine in muscle was unchanged, while flux from phosphocreatine to ATP was 64 +/- 10% of the resting value. This is contrary to the increase in flux of 155% predicted from previous saturation transfer studies carried out in vitro on rabbit skeletal muscle creatine phosphokinase using metabolite concentrations to mimic those in vivo (E.A. Shoubridge, J.L. Bland, and G.K. Radda, Biochim. Biophys. Acta 805, 72 (1984]. This discrepancy could be accounted for by an underestimation of the ADP concentrations to which the enzyme is exposed due to inaccurate assumptions about the total metabolite concentrations, or possibly by compartmentation of creatine phosphokinase and its reactants.

Differentiation of maximal and submaximal knee extension efforts by isokinetic testing

The variability of torque produced during maximal and subject selected submaximal isokinetic knee extension efforst was compared. Subjects were 40 healthy volunteers (20 men and 20 women). Following three warm-up efforts subjects randomly performed one set of both four repeated maximal and submaximal knee extension efforts at 60°/s. Torque was measured at 30 and 45° of flexion and corrected for gravity. Variability of torque was examined by first calculating for each subject the mean, standard deviation (s.d.), and coefficient of variation (CV) for the four trials under the maximal and submaximal conditions. The s.d. was used to represent the absolute variation from the mean, whereas the CV was used to represent the relative variation from the mean. The CVs and s.d.s were compared between the maximal and submaximal efforts using analysis of variance. Variability, as demonstrated by s.d.s, was not consistently greater during submaximal than during maximal efforts. Variability, as demonstrated by CVs, was significantly greater during submaximal than during maximal efforts. In spite of finding statistical differences in the variability of maximal and submaximal efforts, no clear cut-off was identified above and below which performance could be dichotomized into the submaximal and maximal groups based on variability. Relevance Although the variability of angle specific knee-extension torques is greater during submaximal than during maximal efforts, the range of variability associated with maximal and submaximal efforts does not appear to be mutually exclusive. Therefore clinicians should exercise caution in judging the sincerity of an individual's maximal effort based solely on isokinetic measurement variability.

Some Navajo Indian opinions about alcohol abuse and prohibition: a survey and recommendations for policy

In this study a questionnaire was administered to a sample of Navajo Indians in the southwestern region of the reservation to examine (1) their knowledge about the consequences of alcohol abuse and (2) their opinions about alcohol abuse, the etiology of abuse and alcohol legalization. Survey responses indicate that the Navajo surveyed are quite knowledgeable about the various adverse consequences of alcohol abuse. The survey found that 52% of these Navajo adults currently drink at all, and the opinion responses generally characterize alcohol consumption, even in small amounts, as a negative behavior. Sixty-three percent of all Navajos agreed with the popular, but scientifically unsubstantiated, belief that Indians have a physical weakness to alcohol that non-Indians do not have. Alcohol legalization on the reservation is opposed by 81% of the Navajos surveyed. Opinions about alcohol use and policy do not vary greatly even when knowledge of alcohol consequences and current drinking status is considered. The article concludes with a discussion of the importance of positive, solution-oriented public education and debate for entertaining new ideas about alcohol policy and for reducing the sequelae of alcohol abuse among the Navajo.

Prolonged deterioration of ischemic brain energy metabolism and acidosis associated with hyperglycemia: human cerebral infarction studied by serial 31P NMR spectroscopy

We report on a patient with a large ischemic hemispherical stroke studied serially by 31P nuclear magnetic resonance spectroscopy. Persistent hyperglycemia was associated with prolonged acidosis in ischemic brain and failure of high-energy phosphate metabolism to recover. These in vivo human data support the concept that hyperglycemia adversely affects ischemic brain metabolism, pH, and clinical outcome.

Smoking and inflammatory bowel disease in families

Smoking habits of inflammatory bowel disease (IBD) patients were compared with family members with IBD to determine the effects of cigarette smoking on the development of either ulcerative colitis or Crohn's disease. In a previous study of patients randomly selected from the University of Chicago IBD Registry, 40 patients with IBD were identified as having a confirmed IBD family history. Thirty-one of those probands and relatives were contacted and included in this study. Of the 36 patients in the study with Crohn's disease, 78% were former or current smokers, whereas only 27% of the 26 patients with ulcerative colitis were former or current smokers. Eighty-three percent of all those who had ever smoked, started before the onset of symptoms of their disease. There were high concordance rates for type of IBD (81%) and for smoking habits (65%, when a history of smoking was compared with a history of never having smoked) among the matched pairs. The concordance rates were not significantly different from each other, but the magnitude of concordance of each suggests that both smoking habits and consanguinity may be important factors in the pathogenesis of this disease.

Surgeons and others and HIV

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Intracellular acidosis during and after cerebral ischemia: in vivo nuclear magnetic resonance study of hyperglycemia in cats

In vivo 31P nuclear magnetic resonance spectroscopy was used to monitor the time course of intracellular pH in cat cerebral cortex subjected to global cerebral ischemia under control and hyperglycemic pretreatment conditions. Transient (16 minutes) global cerebral ischemia was induced in 14 cats using an inflatable cervical cuff combined with systemic arterial hypotension. Six cats were pretreated with infusion of 1.5 g/kg glucose prior to ischemia. Relative concentrations of high-energy phosphate metabolites and intracellular pH were continuously monitored before, during, and for 2 hours after cerebral reperfusion. During ischemia, intracellular pH fell to the same level and followed a similar time course in both groups. However, during initial reperfusion in the hyperglycemic group, there was a severe further decline (p less than 0.003) in intracellular pH. We suggest that the increased neurologic deficit and mortality found in hyperglycemic animals subjected to cerebral ischemia may be attributed to this transient severe tissue acidosis.

Mycoses caused by Candida lusitaniae

Candida lusitaniae, a fungus with a low incidence of infection in immunocompetent people, is emerging as an opportunistic pathogen in immunocompromised hosts. This yeast is generally resistant to amphotericin B and may present therapeutic difficulties. C. lusitaniae may be misidentified as one of several other fungal species, including Candida tropicalis, Candida parapsilosis, and even Saccharomyces cerevisiae. As judged by in vitro antifungal susceptibility testing, minimal inhibitory concentrations of antifungal agents other than amphotericin B are achievable, but fungicidal levels are not. When encountered in blood or other body sites, C. lusitaniae should be carefully considered as a potential pathogen.

The development of a pH-sensitive contrast agent for NMR 1H imaging

Fe(III)meso-tetra(4-sulfonatophenyl)porphine (Fe-TPPS4) has been investigated as a potential pH-sensitive nuclear magnetic resonance (NMR) proton image contrast agent. Relaxation rates (1/T1 and 1/T2) of water protons were measured as a function of pH and concentration of Fe-TPPS4 in phosphate-buffered isotonic saline. Transverse relaxation rates (1/T2) did not change appreciably with pH above 6.0. Longitudinal relaxation rates (1/T1) increased significantly between pH 7.75 and 5.75. This effect was more pronounced with the increasing concentration of Fe-TPPS4 from 0.1 to 1.5 mM and is attributed to a pH-dependent equilibrium between the high-spin (S = 5/2) Fe-TPPS4 monomer at low pH and the antiferromagnetically coupled mu-oxodimer O-(FeTPPS4)2 at high pH. The efficacy of this pH-dependent contrast agent is demonstrated in vitro.

Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis

The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.

Benefits of high-dose dopamine in experimental neonatal septic shock

The benefits of dopamine resuscitation in neonatal shock are in doubt. To evaluate dopamine's effectiveness on regional perfusion and survival, neonatal pigs were subjected to fecal Escherichia coli peritonitis-induced septic shock and were randomly divided into equal groups. Control animals (Group I) were not resuscitated with dopamine. Dopamine resuscitation, as a continuous infusion of 5 micrograms/kg/min (Group II), 50 micrograms/kg/min (Group III), or 200 micrograms/kg/min (Group IV), began when cardiac output dropped 20% below baseline. Radiolabeled microspheres were used to assess regional perfusion. Survival was defined as no hemodynamic compromise at 24 hr. Increased survival time correlated with sustained increases in cardiac output and blood pressure in Group III, which were not observed in the other groups. Significant changes in multiorgan regional perfusion were also observed in Group III and correlate with the improved survival. These data suggest that higher than usual doses of dopamine may be beneficial in neonates with peritonitis-induced septic shock.

Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia

This retrospective investigation was undertaken to describe and compare the initial and discharge strength deficits of eight upper extremity muscle groups of 42 patients who were hemiparetic secondary to cerebrovascular accidents (CVAs). Static strengths of the eight muscle groups were measured using a hand-held dynamometer, and strength deficits were calculated against the side ipsilateral to the side affected by the CVA. A two-way analysis of variance for repeated measures revealed significant differences (p less than .001) in the strength deficits of the eight muscle groups and between initial and discharge strength deficits. The strength deficits of the shoulder medial rotator and abductor muscle groups were significantly less than those of any other muscle group. No difference was found in the proportion of muscle groups improving in strength in patients tested within six weeks after the onset of hemiplegia versus patients tested six weeks later. Our results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA. The results do suggest that patients improve in muscle strength concurrent with a rehabilitation program.

Upper extremity strength deficits in hemiplegic stroke patients: relationship between admission and discharge assessment and time since onset

This study describes objective upper extremity strength deficits in hemiplegic stroke patients on initial and discharge assessment, and the relationship between these deficits and the time since onset. The static strength of ten different muscle groups had been measured bilaterally in patients (n = 24 to 58, depending on the muscle group), using a hand-held dynamometer. Strength deficits were calculated in relation to the nonparetic side of the body. Zero order correlations were calculated for strength deficit and time variables. Only the relationships between the strength deficits of the initial and discharge assessments were significant (p less than 0.01). These results suggest that the strength deficits of an initial assessment are the best predictors of strength deficits at discharge. This finding has implications for clinicians in clinical decision-making and in addressing patient expectations.

Interrater reliability of a modified Ashworth scale of muscle spasticity

We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.

Effect of pretreatment with propranolol on intra-ocular pressure changes during induction of anaesthesia

It is well documented that intra-ocular pressure (IOP) increases following the administration of suxamethonium and also after laryngoscopy and intubation. It is possible that there may be a final common pathway mediated by beta adrenergic transmission which leads to this pressure rise. If so, this mechanism should be inhibited by beta adrenoceptor blockade. Pretreatment with propranolol prevented a significant rise in IOP during a thiopentone, suxamethonium, intubation induction sequence. The change in IOP was even more pronounced during a thiopentone, alcuronium, intubation induction sequence as the base-line IOP was not regained, but there was significant cardiovascular depression. In both these methods the IOP did not remain stable; there was an initial reduction followed by a rise in pressure. Whether these changes in IOP are clinically important remains an open question.

Influence of propranolol on acidosis and high energy phosphates in ischaemic myocardium of the rabbit

Catecholamines stimulate adenosine triphosphate consumption and glycogenolysis in isolated hearts. In ischaemic myocardium a protective effect of beta adrenergic blockade may therefore arise from reduced adenosine triphosphate consumption or attenuation of acidosis. To characterise the biochemical mechanism of this protective effect phosphorus metabolite concentrations and intracellular pH were measured in an ischaemic region of the rabbit heart in vivo using 31P-nuclear magnetic resonance spectroscopy. After occlusion of the left anterior descending coronary artery there was a rapid decrease in intracellular phosphocreatine concentrations, and intracellular adenosine triphosphate concentrations decreased at a rate of approximately 0.5 mumol X g-1 dry weight X min-1. Intracellular pH decreased approximately linearly to a final pH of about 5.8. In the ischaemic myocardium of the animals treated with propranolol the intracellular concentrations of adenosine triphosphate were higher and those of phosphocreatine lower and the pH was the same compared with control after 30 minutes of ischaemia. Thus any protective effect of propranolol in vivo is not associated with attenuation of intracellular acidosis in this preparation.

Shoulder pain in hemiplegia: statistical relationship with five variables

The incidence of shoulder pain and the statistical relationship between it and five other variables (patient age, time since onset of hemiplegia, range of hemiplegic shoulder external rotation, spasticity and weakness) were investigated retrospectively. Of 50 consecutive hemiplegic patients whose records were reviewed, 36 had shoulder pain. The variables significantly (p less than 0.01) correlated with shoulder pain were: time since onset of hemiplegia (r = 0.45) and ROSER (r = -0.61). The relationship between shoulder pain and range of shoulder motion remained significant when other factors were partialled out. The relationship between shoulder pain and time since onset was not significant when the affect of range of shoulder motion was partialled out. Therefore, range of shoulder external rotation was considered the factor related most significantly to shoulder pain. This finding suggests that shoulder pain demonstrated by hemiplegia patients may be, in part, a manifestation of adhesive capsulitis.

Relationship between independent sitting balance and side of hemiparesis

We conducted a retrospective chart audit of initial physical therapy evaluations to determine the incidence of sitting imbalance and its relationship to the side of weakness in hemiparetic patients. A review of the records of 105 patients revealed that the left side was predominantly affected in 52 patients and the right side in 53 patients. Age, time since onset, and proportion of men and women did not differ between the left and right hemiparetic patients. Most patients (81.0%) could sit independently, but 32.7% of those with left-sided weakness and 5.7% of those with right-sided weakness could not. A chi-square analysis revealed a significant relationship between the side of weakness and independent sitting balance (p less than .001). The phi-square test revealed the strength of this relationship to be .12. Patients with left hemiparesis are more likely to have difficulty with independent sitting than patients with right hemiparesis, which may affect their progress in rehabilitation.

Value Dilemmas and Public Health: A Psychologist's Perspective

We are gathered in memory of our valued colleague Andie Knutson, and I feel particularly honored to have been chosen to speak on this occasion. Andie was a few years older than I, but our lives shared many links. We both had had Social Science Research Council Demobilization Awards following World War II experience, and we had both been involved in the early days of public opinion research. After the war, Andie took his Ph.D. at Princeton with Hadley Cantril, whose holistic and phenomenological orientation in psychology was much influenced by his own doctoral mentor, Gordon Allport, who was also mine. (Our common intellectual heritage made me find Andie's research concerns especially congenial.) After directing research and evaluation and behavioral studies in the U.S. Public Health Service with distinction, Andie came to Berkeley in 1957 (just two years before me) to initiate the program in behavioral sciences in the School of Public Health. He joined the Institute of Human Development as Research Associate at the same time that I did. In 1970, a couple of years after I had left Berkeley, he served the Institute as Acting Director.

A 31P NMR study of the epididymis and epididymal sperm of the bull and hamster

31P NMR signals assigned to intracellular adenine nucleotides and to inorganic phosphate were detected in dense suspensions of epididymal sperm obtained from bulls or hamsters. Similar adenine nucleotide signals and an additional large resonance peak, attributable to extracellular glycerylphosphorylcholine, were observed with whole bovine cauda epididymides. Provision of the glycolytic substrate fructose to such sperm suspensions promoted apparent conversion of intracellular ADP to ATP with a concomitant decrease in cellular inorganic phosphate (Pi) content. Subsequent treatment with the methylxanthine caffeine resulted in diminution of the intracellular gamma-P-ATP signal that was consistent with the decreased ATP and ADP contents previously demonstrated by chemical analyses of cellular extracts. Alternatively, treatment with fructose followed by the membrane-selective detergent digitonin produced loss of the nucleotide NMR signals, indicating release of ATP and Pi from the sperm cytosol with subsequent hydrolysis in the extracellular medium. Comparison of intracellular Pi and ATP resonance signals with those of ATP and Pi in vitro, in media of varied pH and cation composition, allowed calculation of a cytosolic pH of 6.5-6.6 and a cytosolic Mg2+ concentration of 0.5 mM for fresh suspensions of bovine cauda epididymal sperm. Intracellular Pi of hamster epididymal sperm reported a similar cytosolic pH. Other, more acidic compartments were not detected in these experiments. However, during prolonged incubation, the pH of the bovine sperm interior slowly decreased as the extracellular medium was acidified by extensive production of lactate. Intracellular ATP was detectable until cytosolic pH declined to approximately 5.5. Rapid intracellular acidification, resulting from exchange of internal K+ for H+, was observed after treatment with carboxylic acid ionophore nigericin. This lowering of internal pH was followed by a slower return toward initial internal pH values, probably as a consequence of secondary exchange of internal protons for other external monovalent cations, rather than as a result of the operation of a cellular homeostatic mechanism. Together, these studies utilizing noninvasive NMR techniques provide evidence that within the bovine epididymis sperm utilize an unknown energy source to phosphorylate adenine nucleotides and maintain a slightly acidic cytosolic pH.

A comparison of in vivo catalysis by creatine kinase in avian skeletal muscles with different fibre composition

The maximum activity of creatine kinase in vitro is similar in the pectoralis major muscle of the chicken and the duck. However, the flux (phosphocreatine to ATP) as measured by 31P saturation transfer NMR in vivo is almost 2-fold higher in the duck. This apparent discrepancy can be accounted for by the differences in the cytosolic free ADP concentrations in resting muscle.

The role of fetal adrenal hormones in the switch from fetal to adult globin synthesis in the sheep

The switch from gamma (fetal) to beta (adult) globin production was studied by the analysis of globin synthesis in chronically cannulated ovine fetuses and newborn lambs. The gamma/alpha globin synthesis ratio decreased from 0.98 +/- 0.11 (S.D.) (n = 4 samples) at 100-120 days of gestation to 0.15 +/- 0.07 (n = 4) in lambs of 150-156 days post-conception, and the beta/alpha synthesis ratio increased from 0.04 +/- 0.06 (n = 4) to 1.13 +/- 0.21 (n = 4) over the same period. In bilaterally adrenalectomized fetuses, which survived in utero until 151-156 days, the gamma/alpha and beta/alpha synthesis ratios were 0.64 +/- 0.14 (n = 3) and 0.25 +/- 0.07 (n = 3) respectively in the 150- to 156-day period. Bilateral adrenalectomy did not affect the time of onset of beta globin synthesis, but significantly decreased the rate. In one bilaterally adrenalectomized fetus the infusion of increasing concentrations of cortisol restored the rate of beta globin synthesis to normal. Treatment of three intact fetuses with 100 micrograms cortisol/h for 3 weeks, from 100 to 121 days, did not affect the timing or rate of switch from gamma to beta globin synthesis. Thus fetal adrenal secretions, probably cortisol, affected the rate of change of gamma to beta globin synthesis but other factors must have been involved in the initiation of the switch.

HbA2 Victoria delta 24 (B6) Gly----Asp. A new delta chain variant occurring with beta-thalassemia

A new HbA2 variant, HbA2 Victoria delta 24 (B6) Gly----Asp, was identified in a patient with beta-thalassemia. Family studies indicated that the mutant delta gene was trans to the gene for beta-thalassemia.

Hope and despair: keys to the socio-psychodynamics of youth

A psychology of hope and despair is offered, integrating findings from recent psychological research in application to the interpretation of unrest among youth in the 1960s, of present socially problematic behavior, and of response to life under threat of nuclear holocaust. Survey data suggest a complex pattern: the majority of youth are hopeful about their own immediate future, but far fewer are optimistic about their nation and the world. Implications for individual action and social policy are offered.