"Shpos"

The term "shpos" is popular among residents to describe a demanding and difficult patient. On closer examination, a shpos primarily reflects the clash of various narcissistic needs between the resident and his difficult patient. This paper presents several specific observations about the relationship and a short review of narcissism.

[Scale formation in the AMDP (Society for Methodology and Documentation in Psychiatry) system]

The psychopathological and somatic symptoms documented by the AMDP-system on the admission of 1654 patients to the Psychiatric Clinics of the Universities in München und 659 patients in Berlin were factor analyzed. Eight factors could be extracted which describe the psychopathology on eight syndrome-scales. These factors could be cross-validated by factor analyses on random samples. In correspondence with the factors of the AMP-system the following syndromes were found: paranoid-hallucinatory, depressive, psycho-organic, manic, hostility, autonomic, apathy, obsessive-compulsive. For each of the 70 items which were associated with a factor we computed the percentage occurrence and item-scale-intercorrelations, for each of the eight syndrome-scales reliability-coefficients, intercorrelations and T-transformations. For further data-reduction second-order-factors were also computed.

Sentimental work in the technologized hospital

Sentiment is frequently involved in work either to get work done efficiently or because of humanistic considerations. This paper explores several questions: Are there different kinds of sentimental work? How is sentimental work carried out? When and where is it done; when not? Who does it? What is its relation to other types of work? When is it likely to be in focus for the workers? When is it visible, when invisible and to whom? What are its consequences: for work, staff, client and organization? The illustrative materials used in this paper are taken from research on the impact of technology on medical work in hospitals.

Congenital heart disease and respiratory distress syndrome. Reversal of indomethacin closure of patent ductus arteriosus by prostaglandin therapy in a preterm infant

Two relatively large premature newborn infants with respiratory distress syndrome and ductus-dependent congenital heart disease were treated. In one, pharmacologic closure of the ductus arteriosus resulted in severe hypoxemia. The patency of the ductus as reestablished with the infusion of alprostadil (PGE1), until palliative surgery was performed. In the second case, persistent pulmonary hypertension was clinically suspected, and pharmacologic therapy was initiated without adequate cardiac evaluation. In large premature infants with respiratory distress syndrome, closure of the ductus arteriosus should not be attempted before ruling out the presence of ductus-dependent congenital heart disease. Furthermore, pharmacologic closure of ductus arteriosus can be reversed by the infusion of prostaglandin.

Isolation of biochemical mutants using haploid mesophyll protoplasts of Hyoscyamus muticus : I. A NO 3 (-) non-utilizing clone

A population of 3070 clones derived from N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-treated mesophyll protoplasts of haploid Hyoscyamus muticus was tested for amino-acid auxotrophy without enrichment. One clone (MA-2) was stably and specifically dependent on casein hydrolysate and could be fed also by a number of single amino acids or by other reduced nitrogen sources. MA-2 was found to be chlorate resistant and devoid of in vivo nitrate reductase activity under inductive conditions. Permissive and restrictive growth conditions for MA-2 were investigated more closely and media were found promoting morphogenesis. Selection and testing of clones were complicated by an unspecific growth stimulation of some wild type cultures by amino acids, thiamine and m-inositol.

Radiation therapy of malignant melanomas: an evaluation of clinically used fractionation schemes

To assess the importance of radiation dose fraction size in the treatment of malignant melanomas, the records of 48 patients (83 sites) treated at Tufts-New England Medical Center from 1971 to 1979 have been retrospectively reviewed. During this period, the dose fractionation schemes evolved from standard fraction size to large-dose techniques. Radiation fraction size was observed to be the major factor in the clinical response of melanoma. Fractions of 600-800 rad resulted in the best overall response (80%). The rapid fractionation scheme of 800-400-400 rad on successive days resulted in intermediate response (58%) and may be useful for the palliative treatment of selected patients.

[On the practice of clinical therapy with psychotropic drugs -- retrospective investigation of physicians prescribing practices in a psychiatric hospital (author's transl)]

1. At the psychiatric hospital of the University of Munich physicians' practices in prescribing psychotropic drugs have been analyzed retrospectively for 1974. Case report of 2,100 patients from a total of 2,118 newly admitted inpatients in 1974 have been evaluated and various methods of analyzing data are compared. 2. 414 (19.7%) patients out of a total of 2100 have not been medicated by any drugs. On the average 2.7 psychotropic drugs/patient have been precribed in the remaining 1,186 patients (80.3%). 3. 37.4% of 4627 applications made have been allotted to neuroleptics. Clozapine has been found to be the drug most extensively used (37.4%). It was prescribed to 595 patients, followed by chloralhydrate (425 patients) and amitriptyline (374 patients). 4. Out of a total of 5373 prescriptions, 2,004 were allotted to a single substance and 3,369 to a combination of different drugs. With regard to combined medications, in 1,856 prescriptions two drugs were combined, in 1,015 three, in 404 four, in 70 five, in 18 six and finally in 6 prescriptions seven medications were applied to one patient. 5. Antidepressants and neuroleptics have been combined on the same patient in 768 prescriptions. As to neuroleptics most frequently clozapine and haloperidol have been prescribed together. 6. The mean time during which a defined combination of drugs was given continuously, never exceeded a quarter of the total time the individual had been admitted to the hospital. 7. It is evident that in clinical practice the combinations of psychotropic drugs are widely used. This pattern of psychopharmacological drug treatment is in conflict with the present accepted rules of psychotropic pharmacotherapy. Furthermore it is a remarkable result of the present studies that in therapeutical practice the single components of drug combinations are changed very often. Compounds with sedative effects are preferred within all classes of psychotropic drugs.

Allelism of methionine-sensitive mutants of Schizosaccharomyces pombe to loci involved in adenine biosynthesis

Methionine-sensitive mutants ofSchizosaccharomyces pombewere found to map at 16 loci,min1–min16, seven of which are allelic to knownadeloci involved in adenine biosynthesis. The mutantmin1–106was shown to be located within theade6locus by intragenic recombination analysis. Methionine sensitivity of these mutants is reversible by adenine supplementation and their pigmentation is similar to that of the correspondingademutants. We conclude, therefore, that theseminmutants are incompletely blocked in adenine biosynthesis. These observations further indicate that adenine biosynthesis inS. pombeis inhibited by methionine or a metabolite derived from it. For some otherminmutants showing reversibility of methionine sensitivity by leucine or proline, no allelism to knownleuorproloci was detected.

The genetic fine structure of the complex locus aro3 involved in early aromatic amino acid biosynthesis in Schizosaccharomyces pombe

The complex locus aro3 of Schizosaccharomyces pombe was subjected to genetical fine structure analysis. By comparing the complementation map and the meiotic recombination map, the aro3 locus could be subdivided into the five adjacent subregions A, B, C, D and E. Out of 115 aro3 alleles, 26 nonsense alleles and 30 missense alleles could be identified by the criteria of nonsense suppressor sensitivity and leakiness, respectively. Most alleles with a pleiotropic complementation pattern are of the nonsense type. We conclude from the polarity of the complementation patterns characterising the nonsense alleles that the translation direction proceeds from subregion. A to subregion E. Antipolar effects in complementation are more frequent than in the analogous system of the arom gene cluster of Neurospora crassa.

GENETIC MAPPING IN SCHIZOSACCHAROMYCES POMBE BY MITOTIC AND MEIOTIC ANALYSIS AND INDUCED HAPLOIDIZATION

The genetic maps of the fission yeast Schizosaccharomyces pombe were extended through the use of haploidization (spontaneous or induced by m-fluorophenylalanine), as well as by tetrad, random spore and mitotic analysis. A new diploidization method utilizing a meiosis-deficient mutant and improved haploidization techniques was employed. As a result of these and previous studies, 118 genetic markers have been assigned to 3 linkage groups. Centromere markers for all 3 chromosomes were identified and genetic maps containing a total of 71 genes were constructed. Our experiments indicate that 3 is very likely to be the haploid chromosome number of S. pombe.

[Further developments of the AMP-system. A report on the 2nd AMP-symposium and training seminar (author's transl)]

This is a report of a symposium and training seminar of the "Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie" (AMP). Video-recordings of two psychiatric interviews were shown during the seminar and rated by the participants using the AMP-3-Scale (Psychopathology). Aim of the seminar was a rater training and the preparation of an expert standard rating. These videotapes with the corresponding standard ratings will enable the different clinics using the AMP-System to compare their rating behaviour. The process of achieving an expert standard rating is described. The training seminar was followed by a symposium during which a series of lectures was presented on "Standardized Assessment in Psychiatry", The different working groups of the Association reported about their work and future prospects of the Association were discussed.

A demonstration that the current deconcentration of population in the United States is a clean break with the past

An initial reaction among many observers of urban America to recently released data showing a net migration out of its metropolitan areas is that this phenomenon must reflect nothing more than an accelerated expansion of these areas beyond their conventionally defined borders. This paper tests this hypothesis by tracing out the behavior of the Hoover index for five levels of areal disaggregation in the US. In Statistical Geography, Duncan and his collaborators found that for the period 1900–1950 there was dispersal at the finest and coarsest grains of areal disaggregation (reflecting city—suburb and East—West dispersal, respectively) and concentration at intermediate grains (reflecting rural-urban migration). We find that, by 1970, dispersal was occurring at all levels of areal disaggregation. That is, using the county as our basic unit of analysis, and building up increasingly more aggregated regions based on these units, we are unable to find an increase in concentration at any level of areal aggregation. We conclude that dispersal is more than a statistical artifact of the way in which metropolitan areas are defined.

The effects of long-term administration of 3H-digoxin to the pregnant ewe upon the cardiovascular hemodynamics of the fetal lamb

Placental transfer of tritiated digoxin in the ewe and its effect upon the left ventricular output (LVO) of the exteriorized fetal lamb were studied. Seven ewes were given 6 mug per kilogram of body weight of tritiated digoxin daily (20 per cent of total digitalizing dose 0.03 mug per kilogram of body weight) during their entire pregnancies. The fetuses were exteriorized between 130 and 140 days of gestation, and the LVO was determined serially by the dye-dilution technique for one hour. The mean tissue concentrations in millimicrograms per gram for the ewes were: heart, 5.7 plus or minus 1.76; liver, 3.38 plus or minus 1.38, kidney, 01.9 plus or minus 12.3. Corresponding values for the fetuses were: 1.55 plus or minus 1.01, 0.78 plus or minus 0.35, and 2.48 plus or minus 1.18. The mean serum level for the ewe at the end of one hour was 1.65 ng. per milliliter plus or minus 0.48, and that for the fetus was 1.22 plus or minus 0.20. The amniotic fluid contained 1.45 ng. per milliliter plus or minus 0.27. At the end of one hour, the mean LVO of the fetus had decreased by 39 plus or minus 15 per cent of its control value. Although the fetal serum level of tritiated digoxin was similar to that found in the mother and the amniotic fluid contained a significant amount of tritiated digoxin, the fetal tissue concentration of tritiated digoxin was not sufficient to produce any demonstrable inotropic effect.

Idiopathic paroxysmal ventricular tachycardia in infants and children

Seven children with idiopathic PVT ranging in age from one day to 18 yr, have been observed during the past three years. The presenting complaints and frequency of paroxysms varied greatly. Three patients presented with syncope; four were asymptomatic. Lidocaine was effective in terminating acute symptomatic attacks; procaine amide and propranolol were effective in long-term control of the arrhythmia. Monitoring of the dynamic ECG was invaluable in establishing the diagnosis, characterizing the arrhythmia, and evaluating the effects of activity and therapy.