Gingival hyperplasia: a side effect of nifedipine and diltiazem

Currently, calcium channel blockers are being used increasingly for the treatment of hypertension in the elderly. Several case reports in the dental literature suggest that patients treated with the calcium channel blockers manifest gingival hyperplasia similar to that seen in patients taking phenytoin (Dilantin, Parke-Davis). A small study of 89 patients undertaken at the Westside Veterans Administration Medical Center, Chicago seems to indicate that nifedipine and diltiazem do indeed cause gingival hyperplasia. A total of 83% of the patients studied receiving nifedipine showed evidence of hyperplastic tissue and 74% of those on diltiazem were found to have hyperplastic tissue.

Onchocercacidal effects of amocarzine (CGP 6140) in Latin America

An open clinical trial of amocarzine was carried out in onchocerciasis patients in Ecuador and Guatemala. Administration after food was more effective than that during fasting. The most effective and best tolerated regimen, 3 mg/kg twice daily after food for 3 days (in 312 patients), killed 73% of 1477 female worms at nodulectomy 4 months after treatment. The mean microfilarial skin count was greatly reduced within a week (6-11% Of day 0 value on day 8) and it remained low at least 6 months (14-18% on day 180). Follow-up of a higher dose 3 day regimen taken while fasting showed microfilaridermia of 7-9% of the day 0 value 2 years after treatment.

Tobacco smoking increases square-wave jerks during pursuit eye movements

Smooth-pursuit eye-movement (SPEM) abnormalities have been consistently observed in schizophrenia. The SPEM changes in schizophrenia are not thought to be an artifact of voluntary attention or medication, although a number of nondisease factors are known to affect SPEM. However, cigarette smoking has recently been reported to deteriorate SPEM in both smokers and nonsmokers. This finding is particularly relevant to schizophrenia, because schizophrenic patients smoke cigarettes considerably more than do normals, and none of the previous studies in this patient group have controlled for smoking. The current study was initiated to examine the effects of smoking on a number of oculomotor measures, including SPEM in smoker and nonsmoker normal volunteers. The results of this study suggest that cigarette smoking induces or significantly increases square-wave jerks, especially during smooth pursuit in normals. However, the effect is small and the global qualitative SPEM score is not affected. Other eye movements such as latencies for reflex and volitional saccades and saccadic distractibility are also unaffected by smoking. No differences were apparent between chronic smokers and nonsmokers under nonsmoking conditions in any of the eye-movement measures.

Coronary hemodynamic effects of atrial natriuretic peptide in humans

Studies of the effects of atrial natriuretic peptide on the coronary circulation have yielded conflicting results in animals and have not been fully investigated in human subjects. To further characterize the direct coronary hemodynamic actions of atrial natriuretic peptide in humans and to assess the safety of its administration in patients with coronary artery disease, incremental doses of synthetic atrial natriuretic peptide and nitroglycerin were infused into the left coronary artery in 14 patients, 11 of whom had coronary artery disease. Both agents caused dose-related increases in total coronary sinus blood flow. The largest dose of atrial natriuretic peptide given to all patients (100 micrograms) increased mean coronary sinus blood flow from 127 +/- 7 to 149 +/- 9 ml/min (p less than 0.05) and decreased coronary vascular resistance from 0.93 +/- 0.07 to 0.81 +/- 0.05 mm Hg/ml per min (p less than 0.05); mean arterial blood pressure and heart rate were not affected by this dose of atrial natriuretic peptide. The greatest changes in coronary sinus blood flow (+25%) and coronary vascular resistance (-18%) after atrial natriuretic peptide administration occurred in the patients with coronary artery disease and no other associated cardiovascular disease. The maximal effects of atrial natriuretic peptide were similar to those of nitroglycerin, and no untoward effects were observed. Thus, atrial natriuretic peptide is a direct coronary vasodilator in humans. Its maximal dose effects are similar to those of nitroglycerin and were well tolerated in this small group of patients. The physiologic importance and therapeutic potential of atrial natriuretic peptide in patients with coronary artery disease merit further investigation.

The immunosuppressive properties of new oral prostaglandin E1 analogs

Prostaglandins play an important role in cell-mediated immune responses. Their clinical use has been limited by poor oral bioavailability, short half-lives, and significant toxicity profiles. We studied the immunosuppressive properties of new, synthetic, prostaglandin E1 (PGE1) methyl ester analogs (misoprostol, enisoprost) with oral bioavailability using an allogeneic in vitro immunoassay. Our results show that the PGE1 analogs suppress alloproliferative responses and supplement the immunosuppressive activity of cyclosporine and methylprednisolone. Moreover, we demonstrate that addition of recombinant interleukin-2 to the PGE1 analogs restores alloimmune responsiveness and the expression of surface class II antigen and IL-2 receptors on responder lymphocytes. These studies, together with preliminary in vivo data in rodents and man, suggest that the new synthetic oral PGE1 analogs may provide therapeutic efficacy in clinical transplantation and a variety of immunologically mediated diseases.

Prevention of acute graft rejection by the prostaglandin E1 analogue misoprostol in renal-transplant recipients treated with cyclosporine and prednisone

Prostaglandins of the E series have been shown to have immunosuppressive properties. To study the effects of the prostaglandin E1 analogue misoprostol on renal function and graft rejection after transplantation, we conducted a randomized, double-blind, placebo-controlled trial in 77 renal-allograft recipients. The subjects received misoprostol (200 micrograms four times daily by mouth; n = 38) or placebo (n = 39) for the first 12 weeks after transplantation, in addition to standard immunosuppression with cyclosporine and prednisone. They were then observed for an additional four weeks after the drug or placebo was discontinued. Treatment with misoprostol was associated with a significant improvement in renal function as judged by the mean (+/- SEM) serum creatinine concentration (128 +/- 7 vs. 158 +/- 11 mumol per liter after 12 weeks; P = 0.03) and creatinine clearance (84 +/- 6 vs. 69 +/- 5 ml per minute per 1.73 m2 of body-surface area; P = 0.05). There was a significant reduction in the incidence of acute rejection in the group treated with misoprostol as compared with the placebo group (10 of 38 vs. 20 of 39; P = 0.02), and there was less need for rehospitalization after transplantation (4 +/- 1 days with misoprostol vs. 10 +/- 2 days for placebo; P = 0.03). Although blood levels of cyclosporine did not differ significantly between the groups, they tended to be higher in the misoprostol group, as did the incidence of acute nephrotoxicity due to cyclosporine (13 of 38 vs. 8 of 39). Infectious complications tended to be fewer in the misoprostol-treated group (14 of 38 vs. 21 of 39). We conclude that misoprostol improves renal function and safely reduces the incidence of acute rejection in renal-transplant recipients treated concurrently with cyclosporine and prednisone.

Immunosuppressive effect of misoprostol: a new synthetic prostaglandin E1 analogue

Prostaglandins are reported to play an important regulatory role in cell-mediated immunity. The immunosuppressive properties of a new synthetic oral prostaglandin E1 analogue, misoprostol, were studied in vivo in a rat heterotopic cardiac allograft model, and in vitro in mixed lymphocyte reaction. The results show that parenteral misoprostol, alone or in combination with low dose cyclosporin immunosuppressive therapy, significantly prolonged cardiac allograft survival compared with appropriate controls. Oral misoprostol alone in this model did not allow for measurable cardiac allograft prolongation. In vitro misoprostol demonstrated significant dose-response inhibition of the mixed lymphocyte culture assay. It is concluded that new prostaglandin E1 analogues with oral bioavailability may have important applications to clinical transplantation in man, and may be cyclosporin sparing.

Effects of oral prostaglandins on indomethacin-induced renal failure in patients with cirrhosis and ascites

Nonsteroidal antiinflammatory drugs (NSAID), such as indomethacin, reduce production of renal prostaglandins and markedly impair renal function in patients with cirrhosis and ascites. To determine if simultaneous administration of oral prostaglandin analogs minimizes the renal impairment, 10 patients received indomethacin and either misoprostol or placebo in a double-blind, crossover study. Indomethacin reduced urinary sodium from 23 +/- 9 to 8 +/- 4 microEq/min in 4 hours. Misoprostol with indomethacin tended to prevent the fall in urinary sodium (from 35 +/- 15 to 46 +/- 21 microEq/min at 4 hours), but sodium excretion fell to the same level in both groups by 8 hours (6 +/- 3 microEq/min). Indomethacin reduced creatinine clearance in 4 hours by 49%; misoprostol plus indomethacin reduced creatinine clearance by only 34%. Misoprostol tended to minimize or delay the nephrotoxic effects of indomethacin, suggesting that more potent prostaglandin analogs may prevent the renal impairment induced by NSAID.

Phosphorylation of GAP and GAP-associated proteins by transforming and mitogenic tyrosine kinases

The critical pathways through which protein-tyrosine kinases induce cellular proliferation and malignant transformation are not well defined. As microinjection of antibodies against p21ras can block the biological effects of both normal and oncogenic tyrosine kinases, it is likely that they require functional p21ras to transmit their mitogenic signals. No biochemical link has been established, however, between tyrosine kinases and p21ras. We have identified a non-catalytic domain of cytoplasmic tyrosine kinases, SH2, that regulates the activity and specificity of the kinase domain. The presence of two adjacent SH2 domains in the p21ras GTPase-activating protein (GAP) indicates that GAP might interact directly with tyrosine kinases. Here we show that GAP, and two co-precipitating proteins of relative molecular masses 62,000 and 190,000 (p62 and p190) are phosphorylated on tyrosine in cells that have been transformed by cytoplasmic and receptor-like tyrosine kinases. The phosphorylation of these polypeptides correlates with transformation in cells expressing inducible forms of the v-src or v-fps encoded tyrosine kinases. Furthermore, GAP, p62 and p190 are also rapidly phosphorylated on tyrosine in fibroblasts stimulated with epidermal growth factor. Our results suggest a mechanism by which tyrosine kinases might modify p21ras function, and implicate GAP and its associated proteins as targets of both oncoproteins and normal growth factor receptors with tyrosine kinase activity. These data support the idea that SH2 sequences direct the interactions of cytoplasmic proteins involved in signal transduction.

Prostaglandin deficiency

Healthy cells from virtually all tissues synthesize a variety of prostaglandins, autacoids which can significantly alter cellular functions. An absolute or relative deficiency of prostaglandins has now been demonstrated in many diseases or clinical conditions. These include 'natural' disorders such as peptic ulcer disease and diabetes mellitus. These also include 'acquired' or iatrogenic conditions such as cyclosporine nephrotoxicity and the gastropathy induced by nonsteroidal anti-inflammatory drugs. We believe that the diversity of the disorders associated with prostaglandin deficiency may be wider and of greater pathogenetic importance than is currently recognized. We propose: 1) that prostaglandin deficiency will be demonstrated in many abnormalities which are now described as of uncertain etiology; and 2) that adverse effects from many commonly prescribed drugs may also be related to an unrecognized and unfavorable alteration in prostaglandin synthesis, disposal, or activity.

The common src homology region 2 domain of cytoplasmic signaling proteins is a positive effector of v-fps tyrosine kinase function

A conserved noncatalytic domain SH2 (for src homology region 2) is located immediately N terminal to the kinase domains of all cytoplasmic protein-tyrosine kinases. We found that the wild-type v-fps SH2 domain stimulated the enzymatic activity of the adjacent kinase domain 10-fold and functioned as a powerful positive effector of catalytic and transforming activities within the v-fps oncoprotein (P130gag-fps). Partial proteolysis of P130gag-fps and supporting genetic data indicated that the v-fps SH2 domain exerts its effect on catalytic activity through an intramolecular interaction with the kinase domain. Amino acid alterations in the SH2 domain that impaired kinase function interfered with association of the SH2 domain with the kinase domain. Deletion of a conserved octapeptide motif converted the v-fps SH2 domain from an activator to an inhibitor of tyrosine kinase activity. This latent inhibitory activity of v-fps SH2 has functional implications for phospholipase C-gamma and p21ras GTPase-activating protein, both of which have two distinct SH2 domains suggestive of complex regulation. In addition to regulating the specific activity of the kinase domain, the SH2 domain of P130gag-fps was also found to be required for the tyrosine phosphorylation of specific cellular proteins, notably polypeptides of 124 and 62 kilodaltons. The SH2 domain therefore appears to play a dual role in regulation of kinase activity and recognition of cellular substrates.

NMR pulse relaxation studies on the normal aging and cataractous lens

Proton NMR pulse relaxation experiments have been performed in this and other laboratories mainly on animal lenses and some human lenses. In order to evaluate T1 and T2 analyses as a potentially useful (non-invasive) parameter in delineating lenticular changes in normal aging human rabbit lenses, and in human cataracts, we performed a series of pulse relaxation studies on human eye bank lenses 10 to 93 yr of age, on fresh intact human cataracts and on normal rabbit lenses. Additional spectroscopic studies (fluorescence and 31P-NMR) were also performed on the lenses in order to correlate these parameters with the data relating to 'water phases' in the lens. These experiments demonstrate a potential additional parameter for evaluating 'molecular' changes in the aging and cataractous lens.

Photographic and spectroscopic correlations of human cataracts

Intracapsular cataracts obtained within 3 h after surgical extraction were photographed with the CCRG technique and immediately subjected to fluorescence spectroscopy followed by 31P- and 13C-nuclear magnetic resonance (NMR) spectroscopy. Fluorescence spectroscopy demonstrates an excellent correlation between nontryptophan fluorescence intensities and lens color. An interesting correlation was also observed between the degree of light scatter as determined by the 290-nm excitation peak for intrinsic lens tryptophan fluorescence and the CCRG (photographic) appearance of these cataractous lenses. Based on 100 cataracts analyzed, there is a strong correlation between this kind of light scattering measurement and the type and degree of lens opacification. A similar correlation is evident with the 31P-NMR organophosphate profiles in the lenses in which the sugar phosphate levels are elevated only in diabetic patients with cataracts ('diabetic cataracts'). Aside from fluorescence and 31P-NMR spectroscopy, selected lenses were also incubated with 5.5 nM 13C-glucose as soon as they were obtained, and the foregoing spectroscopy was performed, followed by 13C-NMR analyses to detect and monitor for sorbitol accumulation in young versus old normal lenses and in diabetic cataracts. These studies clearly demonstrate a direct correlation between nontryptophan-fluorescent chromophore levels, light scattering (determined by tryptophan excitation peaks), lens age and cataract type. In addition, the organophosphate profiles clearly delineate the diabetic cataracts, and the 13C-NMR spectra correlate well with the age-related decrease in aldose reductase activity.

Two years of cyclophosphamide and 5-fluorouracil as adjuvant chemotherapy for stage II and III breast carcinoma

The results after 6 years of a prospective clinical trial of adjuvant chemotherapy with a regimen of two drugs--cyclophosphamide and 5-fluorouracil (CF)-- for 2 years in 97 women with stage II or III breast cancer are reported. Eligible patients were free from distant metastases. All patients began adjuvant therapy within 4 weeks of surgery; therapy consisted of radical, modified, or extended radical mastectomy. No postoperative radiotherapy was given. The results are compared with a historical control group from previous consecutive patients treated by surgery alone. Patients were stratified by age (younger than 50 or older than or equal to 50) and nodal status (one to three positive axillary nodes vs. four or more positive nodes). The estimated 6-year survival was 60% for CF patients vs. 31% for control patients (P = 0.001). The estimated 6-year disease-free survival was 53.6 and 30.3% for CF and control, respectively (P = 0.007). There was a trend toward longer disease-free survival (DFS) and survival (S) in patients treated with CF, but this was not significant in all the subgroups. Disease-free survival was statistically significant in the subgroup of women greater than or equal to 50 years old with one to three positive nodes (P = 0.038); survival in the patients less than or equal to 49 years old with four or more positive nodes (P = 0.0036); and in patients greater than or equal to 50 years old with one to three lymph nodes involvement (P = 0.038).

Prostaglandins and the release of insulin. A review and a proposal

The effect of prostaglandins or the inhibition of their synthesis on the release of insulin is controversial. Dispute exists because there are apparently disparate experimental results. When the following factors are considered, however, much of the disparity is eliminated: 1) the experimental setting--in vitro or in vivo; 2) the experimental model--animal or human; 3) the experimental additive--the type of nonsteroidal antiinflammatory drug or specific prostaglandin; 4) the relationship of insulin levels to insulin secretion, degradation, and the observed hypoglycemic response. On the basis of such considerations the following conclusions are advanced. 1) From animal studies in vitro it appears that prostaglandins can directly augment insulin release. 2) Results from animal experiments in vivo, however, suggest that systemic prostaglandin administration diminishes insulin release. 3) No human studies have been performed in vitro which examine the insulin secretory response of pancreatic tissue to prostaglandins. 4) Prostaglandins reduce stimulated insulin levels in normal human subjects and in those with diabetes mellitus. Whether insulin secretion is reduced, or clearance is increased, is unknown. 5) Finally, the critical experiment remains to be done, that is the simultaneous examination of insulin, C-peptide, and glucose kinetics during an infusion of a prostaglandin.

Acrylamide and iodide fluorescence quenching studies on whole human lenses and their protein extracts

Tryptophan fluorescence was monitored in whole lenses (and in soluble crystallin fractions derived from these lenses) before and after incubating them in media containing acrylamide or iodide. The effects of exposing one lens to low level broadband UV radiation were compared with the contralateral lens incubated in the dark. In addition we employed 13C labeled acrylamide in order to monitor (by NMR spectroscopy) which crystallins were most effected. These studies demonstrate an acrylamide fluorescence quenching effect in whole lenses and extracted lens proteins, which is directly age related, as is the extent of its incorporation and binding to specific lens proteins. Iodide had no effect on TRP fluorescence in whole lenses and a slight effect on the extracted crystallins. These data demonstrate differences in the microenvironment of TRP residues in the various lens crystallins and their relative susceptibility to low level UV radiation exposure at doses approaching the ambient in vivo levels in a "real life" situation. This approach helps to delineate the microenvironment of TRP residues in native proteins and the effects of UV exposure on proteins with buried versus exposed TRP residues.

Sorbitol generation and its inhibition by Sorbinil in the aging normal human and rabbit lens and human diabetic cataracts

Fresh intact human cataracts (derived from patients with mature-onset diabetes mellitus and from nondiabetic patients), normal human lenses between 2 and 71 years old and lenses derived from 1.5- to 5-kg rabbits were incubated in Earle's media containing enriched 13C-glucose (5 and 15 mM). 31P NMR organophosphate profiles were obtained at the start and end of each incubation. Sorbinil was added to one of each pair of selected lenses, both incubated with 13C-glucose. All the lenses were frozen after 4h of incubation and were subsequently assayed by 13C NMR spectroscopy. The results demonstrate significant sorbitol generation only in young lenses which can be inhibited by Sorbinil. None of the older normal and cataractous human lenses or the mature-onset diabetic cataracts were capable of generating measurable sorbitol levels although they all showed active glucose metabolism and their organophosphate profiles demonstrated normal high-energy phosphate levels. Increased sugar phosphate levels were usually found in the mature-onset diabetic cataracts. Although our NMR spectroscopy is only sensitive to 10(-3) M levels, such concentrations of sorbitol are required to exert their osmotic effects. These data indicate that high sorbitol levels can only be generated in young human and rabbit lenses and correlate well with the age-related changes in aldose reductase activity in these lenses.

Mean circulatory filling pressure: potential problems with measurement

Three experimental series using 22 acutely splenectomized mongrel dogs were completed to 1) compare fibrillation (Fib) and acetylcholine (ACh) injection as methods to stop the heart for the mean circulatory filling pressure (Pmcf) maneuver, and 2) test whether Pmcf equals portal venous pressure 7 s after heart stoppage (Pportal7s). Blood volume changes of -10, -20, +10, or +20 ml/kg were imposed and Pmcf and Pportal measurements were obtained. Pportal7s and Pmcf were significantly different with volume depletion but were similar under control conditions. Pmcf with ACh and Pmcf with Fib were significantly different only after a volume change of -20 ml/kg. However, severe pulmonary congestion and atelectasis were detected in animals where Ach was used to stop the heart. In some cases (with injection directly into the pulmonary artery) the damage was severe enough to cause irreversible arterial hypoxia. Thus we conclude that the repeated use of ACh may exert a detrimental influence on pulmonary function, changing the physiological status of the experimental animal. Also, the central venous pressure at 7 s of heart stoppage (Pcv7s) is not a fully accurate estimate of the true mean circulatory filling pressure during the Pmcf maneuver, because Pcv7s did not equal the Pportal7s under all experimental conditions.

Reconstructive surgery for vasculogenic impotence

A multidisciplinary approach was used to diagnose 12 patients with vasculogenic impotence. Deep dorsal vein ligation was performed in 8 men to treat venous incompetence. Venous arterialization according to the technique of Virag was used in 4 men to treat arterial inflow insufficiency. A 75 per cent success rate was noted for the correction of venous incompetence. With an average followup of 1 year, excellent success was achieved in re-establishing corporeal blood flow with the technique of venous arterialization plus creation of a venocorporeal shunt.

Postoperative whole lung irradiation with or without adriamycin in osteogenic sarcoma

Thirty-six patients with histologically proven osteogenic sarcoma of the extremities, treated between September 1975 and April 1978, are the subject of this report. The primary tumor was treated with radical surgery. Patients received 2000 cGy whole lung irradiation postoperatively in an attempt to control micrometastases to the lung. Twenty-nine of the patients were given Adriamycin (60 mg/m2 IV every 6 weeks for a total dose of 550 mg/m2) in addition to the irradiation. The median, disease-free interval was 118 days for the seven patients treated with lung irradiation only. The median overall survival for these patients is 241 days, with one patient alive with disease. All patients developed lung metastasis. For the 29 patients treated with postoperative lung irradiation and Adriamycin, the median disease-free interval was 372 days, and the median overall survival is 843 days. Nineteen of the patients recurred (65.5%). The differences are statistically significant (p less than or equal to 0.003, median disease-free survival and p less than or equal to 0.03, median survival). This study supports the role of whole lung irradiation plus Adriamycin, in the control of micrometastases in osteogenic sarcoma of the extremities and suggests that additional clinical trials are warranted.

Developmental changes in salt acceptability in human infants

Human infants less than 4 months of age ingested water and moderate concentrations of sodium chloride solution (0.10-0.20 M) in equal amounts. In contrast, infants 4-24 months of age exhibited heightened acceptance of saline solution relative to water. Such a developmental change in salt acceptability is consistent with a hypothesis of postnatal maturation of peripheral and/or central structures underlying this response. Children 31-60 months of age tended to reject saline solution relative to water. This change may in part reflect the effects of experience.

Cyclosporine in heart and heart-lung transplantation

At Stanford University Medical Center from January 1968 until January 1984, 288 patients received 313 heart transplants. The immunosuppressive regimen before December 1980 consisted of azathioprine and prednisone, with or without rabbit antithymocyte globulin. After that time cyclosporine replaced azathioprine. In 92 recipients of 95 heart allografts, the 1- and 3-year survival rates were 82% and 65% to 70% respectively. In the 3 years from March 1981 to March 1984, successful heart-lung transplantation was accomplished in 13 of 19 recipients, using cyclosporine-based immunosuppression. Survival ranged from 1 to 38 months. While it is true that cyclosporine has improved survival in heart transplant recipients, has allowed successful heart-lung transplantation to be performed, has shortened intensive care unit and total hospital stays and therefore hospital costs, and has allowed easier management of rejection and infection, several disconcerting problems have not yet been resolved. These include hypertension that is difficult to control and renal dysfunction in all patients, and the fact that cellular and humoral rejection still occurs, as manifested by graft atherosclerosis, bronchiolitis obliterans and classic acute rejection. Better understanding and application of cyclosporine immunosuppression will undoubtedly minimize both cyclosporine- and non-cyclosporine-related postoperative complications and will improve survival even further.

Cost sharing in corporate benefit plans: the cases of Gulf Oil and DuPont

In 1983 the Health Systems Management Center of Case Western Reserve University contracted with the Business Roundtable Health Initiatives Task Force to use BRT's survey of members as a guide to the top firms who had taken action regarding health care costs and more importantly, had also evaluated the cost implication of that action. The mandate was to draw together representative case studies on seven firms who met those criteria for use in BRT educational seminars and elsewhere. These cases may provide important insight for other companies which are contemplating action regarding their health care costs. They should also lead to further research on alternative actions available and the means of evaluation that should be considered. Most importantly they may provide some methodology for top management to choose among proposals for attacking this burgeoning corporate cost. Two of the case studies selected as representative were DuPont Corporation and Gulf Oil Corporation. Both DuPont and Gulf Oil, increased the level of cost sharing through copayments and deductibles and improved administrative efficiency by consolidating multiple plans into a limited set of options available to all employees nationally under an administrator chosen by competitive bid. Both plans were evaluated by projecting experience that might be expected under the former arrangements with consideration of biases due to adverse selection among options. This was compared with actual experience to reveal substantial savings in each case which should be replicable elsewhere under similar circumstances. Unfortunately, lack of suitable controls and comparisons limits the confidence in the precision of these evaluations.

Acceptance of sweet and salty tastes in 2-year-old children

Taste acceptability, determined by volume of taste substances consumed during brief presentations, was assessed in 63 black 2-year-old children who had previously been tested at birth and at 6 months of age. Intake of sucrose solutions during taste tests was related to prior dietary exposure to sugar water. Children who had been regularly fed sugar water by their mothers consumed more sucrose solutions but not more water than did children whose mothers did not feed them sugar water. However, when these children were tested with sucrose in a fruit-flavored drink base, prior exposure to sugar water was unrelated to consumption of sweetened or unsweetened fruit-flavored drink. Thus, the apparent effects of dietary exposure on sucrose acceptability were specific to the medium in which sucrose was dissolved. Studies with sucrose solutions also revealed a significant correlation between sucrose acceptability determined at 6 months and at 2 years of age. Another series of tests evaluated response to salt with soup and carrots. Individual children who ingested more salty than plain soup also tended to ingest more salty compared with plain carrots. However, measures of salt consumption and salt usage obtained from mothers were unrelated to individual differences in acceptability of salty foods.

Vitreous changes after neodymium-YAG laser irradiation of the posterior lens capsule or mid-vitreous

Exposure of four monkey and 26 rabbit eyes to neodymium-YAG laser irradiation to the posterior lens capsule or the mid-vitreous area clearly demonstrated significant vitreous changes (liquefaction) as measured by viscosity analyses and proton relaxation studies. We found marked molecular alterations in the vitreous of the exposed eye compared with the contralateral control (unirradiated) eye. These alterations, occurring immediately after laser treatment, were probably the result of acoustic transients accompanying the laser irradiation.

Oat cell carcinoma of the larynx and Eaton-Lambert syndrome

Oat cell or undifferentiated small cell carcinoma is a rare malignant tumor of the larynx. Since this lesion was first described, only 23 cases have been reported in the literature. Oat cell carcinoma of the lung, however, accounts for 20% to 25% of all lung cancers and is frequently associated with a variety of paraneoplastic syndromes. A 64-year-old woman had a primary oat cell carcinoma of the supraglottic larynx associated with clinical and electromyographic evidence of the myasthenic syndrome of Eaton-Lambert. To our knowledge, this is the first description an oat cell carcinoma of the larynx associated with this syndrome, which supports the theory that oat cell cancers of the larynx and lung have a common histogenesis.

ECG findings in geriatric depressives given trazodone, placebo, or imipramine

ECG effects were evaluated in 60 depressed geriatric patients in a drug-free baseline state and weekly during treatment with trazodone, placebo, or imipramine. Eighteen patients underwent crossover from placebo or imipramine to trazodone. Imipramine increased heart rate and was associated with more isolated ECG complications. Trazodone and placebo did not increase heart rate and had no other significant ECG effects.

Sodium regulation: Sensory aspects

A first step in reducing salt intake is to understand sensory control of ingestion. Salt and taste, the methodology for studying taste in human beings, the development of response to salt by infants and children, and dietary sodium and salt preference are discussed. The author's conclusion is that at present it is not possible to answer the question of why people consume as much salt as they do. More research is needed.

Pulmonary function tests during adjuvant lung irradiation for osteogenic sarcoma

Six patients received whole-lung irradiation at a dose of 2000 rads/4 weeks (nominal standard dose = 700 Rets) after surgery for primary osteogenic sarcoma. Pulmonary function tests performed before and 6-20 months after pulmonary irradiation failed to demonstrate any pulmonary function impairment in any of the patients studied.

Systems releasing action therapy with alcoholics: an experimental evaluation

Described Systems Releasing Action Therapy (SRAT) and a controlled study that evaluated its effectiveness. The therapy combines physical and fantasy exercises and has its roots in the Bioenergetic and Gestalt traditions. To evaluate its effectiveness, 56 patients who were receiving treatment for alcoholism were assigned randomly to therapy and control groups. On 3-week follow-up, the therapy sample showed significantly more improvement than the controls on measures of blood pressure, physical symptoms, anxiety, hysteroid tendencies, disturbed feelings and self-image. Suggestive differences (interactions significant only at the .20 level) in favor of the therapy group also appeared on measures of vital capacity withdrawal, excessive drinking, anhedonia and four neurosis-oriented MMPI scales. However, 6-month follow-up data were relatively unimpressive. The results suggest this type of therapy is an effective one, at least for the short term.

Adjuvant whole-lung radiation with or without adriamycin treatment in osteogenic sarcoma

Eighteen consecutive patients with osteogenic sarcoma were treated after initial surgery with 2000 rads of whole-lung radiation for 21--28 days. Eleven of these patients went on to receive adriamycin (20 mg/m2 X 3 days every 6 weeks). Three of seven evaluable patients are free of disease in the radiation group (median time to recurrence, 130 days) while six of ten evaluable patients are free of disease in the radiation + adriamycin group (median time to recurrence, 310+ days). These results are similar to published experience with whole-lung radiation and adriamycin alone.