High-resolution sonography detects extraforaminal nerve pathology in patients initially diagnosed with cervical disc disease: a case series

In patients presenting with neck and upper limb complaints, MRI changes suggestive of cervical disc disease do not exclude concomitant extraforaminal pathology, as shown in the series of three cases presented here. High-resolution ultrasound of the brachial plexus and peripheral nerves may be useful in identifying an extraforaminal pathology when (1) symptoms and signs are disproportionate to MRI findings of cervical disc disease; (2) there is obvious discordance between MRI and nerve conduction findings; (3) an entrapment neuropathy is suspected but the site of nerve lesion is unidentifiable on the basis of available investigations and clinical findings.

High definition ultrasound as diagnostic adjunct for incomplete carpal tunnel release

Carpal tunnel syndrome is the most common nerve entrapment in the upper limb and carpal tunnel release (CTR) provides the most predictable outcome and relief of symptoms. Incomplete carpal tunnel releases are uncommon, however, in the event of incomplete surgical releases, symptoms following such incomplete releases tend to be more severe than the symptoms presented at the initial complaint. We present our experience in utilizing high definition ultrasound to reliably and accurately localize the anatomical cause to aid focused revision CTR.

Quantification of corticosteroid-induced skin vasoconstriction: visual ranking, chromameter measurement or digital imaging analysis

Topical corticosteroid formulations have been evaluated by visual grading protocols for many years. Toward a more objective methodology, several instrumental methods have been evaluated for applicability in quantifying the vasoconstriction side-effect that follows corticosteroid application to the skin. Although the chromameter has been adopted by regulatory bodies throughout the world as the current standard for topical bioequivalence determinations, there is considerable criticism of this instrument from several quarters. A preliminary comparison reported here indicates that digital image analysis provides statistically significant results that are similar to those obtained by visual assessment techniques, and shows considerably greater precision than that obtained by the chromameter. Continued evaluation of objective assessment techniques, such as digital imaging, and continued modernisation of regulatory bioequivalence requirements will assist in protecting patients and optimising clinical results.

Magnetic resonance imaging after operative repair of achilles tendon rupture

We performed a magnetic resonance imaging (MRI) study in 16 consecutive patients who had undergone open repair of a unilateral Achilles tendon rupture (ATR) at an average of 32.5 (SD 3.2) (range 29-36) months from the operation. We measured the widest antero-posterior diameter of the tendon, the longest distance between the insertion of the Achilles tendon on the calcaneum and the musculo-tendinous junction of the soleus muscle on the Achilles tendon, the distance between the insertion of the Achilles tendon on the calcaneum and the point of maximal width of the tendon. We also ascertained whether areas of altered signal were present in and around the tendon. The operated tendons were always significantly thicker than the non-operated ones. There was a non-significant trend for the other measurements to be greater in the operated tendons. In five patients, areas of dishomogeneous signal were present in the operated tendon. These areas were less than 25% of the antero-posterior diameter of the tendon, and were clinically silent. These findings probably represent normal features of long-term tendon healing following open repair of an ATR.

Effect of concentration and degree of saturation of topical fluocinonide formulations on in vitro membrane transport and in vivo availability on human skin

PURPOSE

The thermodynamic activity of drugs in topical vehicles is considered to significantly influence topical delivery. In vitro diffusion across a synthetic membrane was shown to be correlated to the degree of saturation of the drug in the applied vehicle and therefore offers a potential for increased topical drug delivery. Fluocinonide a topical corticosteroid, was chosen as a model compound to investigate in vitro and in vivo availability from formulations with different degrees of saturation.

METHODS

Sub-, as well as, supersaturated drug solutions were prepared using PVP as an antinucleant agent. In vitro membrane diffusion experiments across silicone membrane and in vivo pharmacodynamic activity assessments, using the human skin blanching assay, were carried out.

RESULTS

Over the concentration range studied, the in vitro membrane transport of fluocinonide was proportional to the degree of saturation of the respective formulations. The in vivo pharmacodynamic response in the human skin blanching assay was related to the concentration of the drug in the vehicle irrespective of the degree of saturation.

CONCLUSIONS

From the membrane permeation experiment it can be concluded, that the drug flux might be increased supra-proportionally with increasing donor concentration, drug (super-)saturation (proportional), beyond what would be anticipated based on ideal donor concentration and partition coefficient considerations only. These findings could not be confirmed in the in vivo investigation, probably due to additional vehicle effects (e.g., enhancement, irritation, drug binding) which have to be expected and could have altered the integrity of the stratum corneum and therewith topical bioavailability of the drug.

Analysis of chromameter results obtained from corticosteroid-induced skin blanching assay: comparison of visual and chromameter data

In a Guidance document, the American FDA recommends the use of a Minolta chromameter rather than the human eye for the quantitative assessment of the pharmacodynamic blanching response produced by topical application of corticosteroids. The purpose of this study was to compare the appropriateness of the human eye and two models of chromameter for the estimation of skin blanching, in terms of the quality of the data generated by each method. The corticosteroid-induced skin blanching from four different betamethasone 17-valerate cream formulations was compared in a typical human skin blanching trial. The optimized assay methodology routinely practised in our laboratories was utilized. The blanching responses were assessed visually by three trained, independent observers and recorded by two chromameters (Minolta model CR-200 and model CR-300). The topical availability of the four creams was determined using visual scoring and chromameter measurements. All data were manipulated in such a manner as to produce a blanching response versus time profile from which AUBC analysis could be performed. Good correlation was observed between the visual assessments made by three independent observers. In contrast, moderate correlation was determined between visual, CR-200 and CR-300 measurements. Surprisingly, no direct linear relationship between the AUBCs produced by the two chromameters was observed indicating that the quality of the data obtained from the two instruments may not be equal. This investigation also indicated that the use of the chromameter is not completely objective. Visual scoring and chromameter measurement produce data sets that differ in quality. Each procedure needs to be validated and investigators have to be trained for both visual assessment and the operation of the chromameter, particularly with regard to the manipulation of the measuring head of the instrument.

Lactate distribution in the blood during steady-state exercise

PURPOSE

The purpose of this investigation was to examine the plasma to red blood cell (RBC) lactate concentration ([La]) gradient and RBC:plasma [La] ratio during 30 min of steady-state cycle ergometer exercise at work rates below lactate threshold (<LT = approximately 40% of peak cycle ergometer O2 uptake ¿VO2peak¿) and above LT (approximately 70% of VO2peak).

METHODS

Eight subjects (cycling VO2peak = 41.6+/-1.6 mL x kg(-1) x min(-1); LT = 57.9 + 1.2% VO2peak) performed 30 min of cycle exercise at intensities < and > LT. Blood samples were taken from a heated forearm vein, immediately cooled to 4 degrees C in a dry-ice ethanol slurry, and centrifuged at 4 degrees C to separate plasma and RBCs.

RESULTS

During >LT, plasma [La] rose to 8.8+/-1.1 mM after 10 min and remained above 6 mM. RBC [La] (4.9+/-0.7 mM) was significantly lower than plasma [La] at 10 min and remained lower throughout exercise. As a result, there was a sizable [La] gradient (approximately 3.5 mM) from plasma to RBC during most of >LT. In <LT, plasma [La] increased only slightly from rest (1.6+/-0.2 mM) after 6 min (2.4+/-0.3 mM) and then declined to approximately 2 mM for the remainder of the trial. The plasma to RBC [La] gradient averaged approximately 0.8 mM throughout <LT. Despite drastically different plasma to RBC [La] gradients in <LT and >LT, the ratio of RBC [La]:plasma [La] was the same for both (0.58+/-0.02) and not significantly different from rest.

CONCLUSIONS

These results refuted our hypothesis that the RBC:plasma [La] ratio would decrease at the onset of >LT exercise because of muscle lactate release exceeding the ability of RBCs to take up the lactate. Instead, there appears to be an equilibrium between plasma [La] and RBC [La] in arterialized venous blood from a resting muscle group as evidenced by the constant RBC [La]:plasma [La] ratio.

Lactate influx into red blood cells from trained and untrained human subjects

PURPOSE

The purpose of this study was to compare the fractional contributions of the three pathways of lactate transport (band 3 system, nonionic diffusion, and monocarboxylate pathway) into red blood cells (RBC) from trained and untrained humans.

METHODS

Blood samples were obtained from 19 male subjects: 5 untrained, 5 aerobically-trained, 5 competitive collegiate cross-country runners, and 4 competitive collegiate sprinters. The influx of lactate into the RBC was measured by a radioactive tracer technique using [14C]lactate. Discrimination of each pathway of lactate transport was achieved by using PCMBS (1 mM) to block the monocarboxylate pathway and DIDS (0.2 mM) to block the band 3 system. Nonionic diffusion was calculated as the difference between total lactate influx and the sum of band 3 and monocarboxylate lactate influx.

RESULTS

Total lactate influx into the RBC from the more aerobic individuals (trained subjects and cross-country runners) was significantly faster at 1.6 mM lactate concentration ([La]) as compared with the influx into RBC of the untrained subjects. Total influx of lactate was significantly higher (P < 0.05) in the RBC from the sprinters as compared with that in the RBC from the untrained subjects at 41 mM [La]. There were no significant differences among the four groups with regard to the total influx of lactate at 4.1, 8.1, and 20 mM [La]. In general, the percentage of total lactate influx accounted for by each of the three parallel pathways at 1.6, 8.1, and 41.0 mM [La] was not different among the four groups of subjects.

CONCLUSIONS

Overall, the groups were more similar than different with regard to RBC lactate influx.

Analysis of chromameter results obtained from corticosteroid-induced skin blanching. I: Manipulation of data

PURPOSE

One of the unresolved issues in the FDA Guidance document for topical corticosteroid bioequivalence testing is the method of manipulation suggested for the chromameter data. The purpose of this study was to manipulate the instrumental data from a typical blanching study in a number of ways to investigate the appropriateness of these procedures for comparison with the subjective visually-assessed results.

METHODS

The human skin blanching assay methodology routinely practiced in our laboratories was utilised and the vasoconstriction produced by two corticosteroid formulations of different potency was assessed visually and instrumentally by use of a Minolta chromameter. The instrumental data were corrected for zero-time and unmedicated site readings. In addition, Euclidean distances were calculated using all data generated by the instrument.

RESULTS

Individually the a-, b- and L-scale chromameter values are imprecise and there is negligible vasoconstriction response recorded for the moderately potent formulation. Arithmetical manipulation of the data as suggested by the FDA does not appear to improve the quality of the data in any way. Euclidean distance analysis more closely resembles the visual data and appears to have better precision.

CONCLUSIONS

It is clear that mathematical correction of chromameter data is unnecessary, especially since the instrumental data are extremely imprecise. Furthermore, the assessment of each individual chromameter index does not adequately characterise the blanching response profile. It is therefore suggested that Euclidean distance may be a better measure on which to base an analysis of bioequivalence than the truncated data set methodology currently suggested by the FDA.

Projected animal preferences in incarcerated and nonincarcerated men

Consistent with Bender and Rapoport's suggestion and clinical experience, the present study of 93 inmates and 106 college men supports that the wish for freedom, to “take flight,” may be symbolized in projective material by a bird.

Lactate distribution in the blood during progressive exercise

The purpose of this study was to examine the effect of increment durations of 1-min and 4-min during progressive incremental exercise tests on: 1) the distribution of lactate between plasma and red blood cells (RBCs), and 2) lactate threshold (LT) detection via three conventional methods using whole blood lactate concentration ([La]) or plasma [La]. Eight males (age, 22.5 +/- 0.6 yr: height, 170.6 +/- 2.3 cm, weight, 76.0 +/- 3.1 kg, and VO2peak, 42.8 +/- 2.0 mL.kg-1.min-1) performed two progressive load tests to volitional fatigue on a cycle ergometer. Work rate was increased 30 W at 1-min or 4-min intervals. All data were normalized to individual LT work rates. For both protocols, whole blood [La], plasma [La], RBC [La], and [La] gradient increased significantly (P < 0.05) after exercise intensity exceeded LT. However, the RBC:plasma [La] ratio remained at the resting value throughout the progressive exercise tests. The increase in [La] gradient after LT, with no change in the RBC:plasma lactate ratio, suggests that given an incremental work rate increase of 30 W, 1 min is adequate for equilibration of lactate between the plasma and RBCs. Also, under the conditions of this investigation, neither blood fraction analyzed nor exercise protocol had any effect on estimations of LT (in terms of VO2) by the Visual and Log-Log methods. However, LT determined by a fixed [La] of 2 mM may underestimate LT when plasma samples are used.

Evaluation of the proposed FDA pilot dose-response methodology for topical corticosteroid bioequivalence testing

PURPOSE

The American FDA has recently released a Guidance document for topical corticosteroid bioequivalence testing. The purpose of this study was to evaluate the recommendations of this document for appropriateness. The new specifications require a dose-vasoconstriction response estimation by the use of a Minolta chromameter in a preliminary pilot study to determine the parameters for use in a pivotal bioequivalence study.

METHODS

The visually-assessed human skin balancing assay methodology routinely practiced in our laboratories was modified to comply with the requirements of the pilot study so that visual and chromameter data could be compared. Two different cream formulations, each containing 0.12% betamethasone 17-valerate, were used for this comparison.

RESULTS

Visual data showed the expected rank order of AUC values for most dose durations whereas the chromameter data did not show similar results. The expected rank order of AUC values for both chromameter and visual data was not observed at very short dose durations. In fitting the data to pharmacodynamic models, equivalent goodness of fit criteria were obtained when several different parameter estimates were used in the model definition, however the visual data were best described by the sigmoid Emax model while the chromameter data were best described by the simple Emax model.

CONCLUSIONS

The Emax values predicted by the models were close to the observed values for both data sets and in addition, excellent correlation between the AUC values and the maximum blanching response (Rmax) (r > 0.95) was noted for both methods of assessment. The chromameter ED50 values determined in this study were approximately 2 hours for both preparations. At this dose duration the instrument would not be sensitive enough to distinguish between weak blanching responses and normal skin for bioequivalence assessment purposes.

Lactate influx into red blood cells of athletic and nonathletic species

Transport of lactate across the erythrocyte membrane proceeds by three distinct pathways: 1) nonionic diffusion of lactic acid, 2) inorganic anion exchange (band 3), and 3) a monocarboxylate-specific (MC) carrier mechanism. This study determined the contributions of these three pathways in the red blood cells (RBCs) of "athletic" and "nonathletic" species. Blood samples were obtained from four male animals of each species: 1) Canis familiaris (dogs), 2) Capra hircus (goats), 3) Equus caballus (horses), and 4) Bos taurus (cattle). Contribution of each pathway to total lactate influx was determined by measuring L-[14C]lactate influx into lactate-depleted control RBCs, p-chloromercuribenzenesulfonic acid (PCMBS)-treated (1 mM) RBCs, and 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS)-treated (0.2 mM) RBCs at three lactate concentrations ([La] values 1.6, 8.1, and 41 mM). PCMBS blocked MC transport and DIDS blocked the band 3 pathway. Lactate influx into the RBCs of the athletic species was 4-160 times faster (P < 0.05) than influx into the RBCs of the nonathletic species at 8.1 and 41 mM [La] values. Nonionic diffusion was greater in the RBCs of nonathletic animals (approximately 7-25%) than in the RBCs of athletic animals (approximately 4%). A significantly higher percentage of the total lactate influx occurred via the band 3 system in the RBCs from the nonathletic animals (approximately 56-83%) vs. the RBCs from the athletic animals (approximately 6-7%) at all [La] values.(ABSTRACT TRUNCATED AT 250 WORDS)

Clothing and exercise. I: Biophysics of heat transfer between the individual, clothing and environment

Despite large environmental variations, the human body maintains a tightly regulated core temperature. Effective thermoregulation must balance the interaction between skin surface, clothing and ambient air. Indices of thermal stress (wet bulb globe temperature, heat stress index, maximum evaporation rate, required evaporative rate and wind chill) provide valuable information concerning the heat exchange between the individual and the environment, and serve as protective guidelines while working in environmental extremes. The role of clothing, as an interactive barrier, greatly affects thermal balance. Clothing is varied according to prevailing environmental conditions, metabolic heat production, gender and age differences, fabric thermal properties, garment design and intended use. Models (static, dynamic and human) have investigated the biophysical transfer of heat between the skin surface area, clothing and ambient air. Additionally, the role of metabolic heat production during exercise can greatly influence tolerance to thermal stress during a variety of environmental conditions.

Sensitivity of different areas of the flexor aspect of the human forearm to corticosteroid-induced skin blanching

The intensity of corticosteroid-induced blanching has been found to vary at different areas of the flexor aspect of the human forearm. A retrospective analysis of 38,880 observations of skin blanching in 56 volunteers was conducted to assess the sensitivity of forearm skin to betamethasone 17-valerate. The mid-forearm appears to be more sensitive to the blanching response than do the areas close to the wrist or elbow. These results indicate that each preparation under evaluation should be applied to several sites along the forearm when using the human skin blanching assay in order to obtain an accurate comparative assessment of corticosteroid release from topical delivery vehicles.

The local side effects of transdermally absorbed nicotine

Percutaneous nicotine administration induces predominant sudorific and rubiform responses in the skin which may be accompanied by subtle piloerection, hyperalgesia and pruritus (although these signs are not overtly manifest). These dermal responses are complex and mechanisms have been proposed for the direct nicotine-stimulation of sweat glands, piloerection and vasoconstriction. These reactions are accompanied by secondary activation and release of vasodilator peptides which produce a predominating vasodilator tone following topical administration, this response masking the direct axon reflex-mediated vasoconstriction.

Blanching activities of betamethasone formulations. The effect of dosage form on topical drug availability

The blanching activities of Betnovate cream, lotion, ointment and scalp application (each containing 0.1% betamethasone (as the 17-valerate] were determined using healthy human subjects over a 32 h period in both the occluded and unoccluded modes. Considering that all four formulation types contained the same label concentration of corticosteroid, it may be presumed that the formulations would show similar topical drug availability: this was, however, not found to be the case. The scalp application demonstrated the highest topical availability in both the occluded and unoccluded modes. The lotion formulation showed the greatest increase in topical availability on occlusion and the ointment formulation was the least sensitive to the effects of occlusion. These differences, due solely to the effects of the vehicle, may have important clinical implications.

Potency ranking of two new topical corticosteroid creams containing 0.1% desonide or 0.05% halometasone utilising the human skin blanching assay

The human blanching assay was used to assess the potency of two new proprietary corticosteroid creams. The blanching abilities of 0.1% desonide cream and 0.05% halometasone cream were evaluated relative to the blanching elicited by 0.05% clobetasol 17-propionate cream, 0.1% betamethasone 17-valerate cream and 0.05% clobetasone 17-butyrate cream. The results of the trial indicated that the 0.1% desonide cream falls into the potent group of topical corticosteroid preparations and the 0.05% halometasone cream falls into the moderately potent group.

Optical effects of aircraft boundary layer turbulence

A simple model is presented for the optical distortion experience by an airborne optical telescope. This model evaluates the distortion produced by a layer of turbulent air in front of the telescope. A correlation length for the boundary layer is introduced, and theoretical considerations predict that this correlation length should be proportional to the 6/5th power of the wavelength. Comparisons to experimental observations confirm this prediction thereby indicating that the distortion experienced by an airborne telescope dominated by turbulent air rather than mechanical vibrations or thermal stress.

Care to AIDS patients: the cost impact on Medicare

Medicaid is currently providing necessary services to approximately 40 percent of AIDS sufferers who have no other sources of payment and met eligibility requirements of the program. For those AIDS patients, states can exercise current Medicaid Program flexibility in adopting innovative delivery systems to provide high quality care in the most cost-effective setting. This will enable Medicaid-eligible AIDS sufferers to receive care in a wide range of settings and hopefully alleviate as much suffering as possible during the course of the disease. HCFA will continue to monitor the effects on Medicaid of care provided to AIDS patients by seeking current and relevant information from all available sources. This will enable us to better estimate the cost impact to the Medicaid program of providing care to Medicaid-eligible persons with AIDS.

Detection of chemicals inhibiting photorespiratory senescence in a large scale survival chamber

A large scale survival chamber was developed as a screen for detecting chemical treatments that extend the survival time of illuminated soybean seedlings at CO(2) concentrations below the compensation point. In theory, extended survival should indicate potential for improved crop performance via decreased photorespiration and increased photosynthetic efficiency. An automated control system regulated CO(2) concentrations, temperature and plant watering during a continuous CO(2)-removal photoperiod of 72 hours. An endogenously controlled circadian rhythm of net photosynthesis occurred throughout the continuous light treatment.Spray applications of 3.49 millimolar 2-(4-chlorophenoxy)-2-methylpropanoic acid (CPMP) significantly decreased leaf chlorophyll loss, compared with the control, after 72 hours of subcompensation-point stress. Treatment with CPMP also consistently increased leaf chlorophyll per unit area under nonstress greenhouse conditions. These effects may be due to increases in specific leaf weight produced by CPMP although the compound did not consistently act as a height retardant. The compound, 3-butyl-2-hydroxy-4H-pyrido[1,2-a]pyrimidin-4-one (BHPP), inhibited senescence under low CO(2) conditions but did not decrease leaf light transmission at ambient CO(2) levels. The cytokinin N(6)-benzyladenine (BA) retarded low CO(2) stress senescence although greening effects were not observed. Neither 2-hydroxy-3-butynoic acid (HBA) nor its butyl ester, inhibitors of glycolate oxidase, influenced low CO(2) survival. Cyclohexanecarboxylic acid (CHCA) and sodium naphthenate had no effect upon subcompensation-point senescence.Antisenescence effects of CPMP, BHPP, and BA do not appear to be directly attributable to effects upon the competing carbon paths of photosynthesis and photorespiration. Protection against low CO(2) stress and increased chlorophyll synthesis under nonstress conditions may represent separate effects upon plastids by some of the compounds. This screen will identify compounds which inhibit photorespiratory senescence without decreasing the CO(2) compensation point.

Effects of Chemical Treatments upon Photosynthetic Parameters in Soybean Seedlings

The effects of various chemical treatments upon photosynthesis, soluble leaf protein, CO(2) compensation point, and leaf light transmission in soybean, Glycine max (L.) Merr., seedlings were examined following varying response periods after application at 14 to 17 days postemergence. The compounds N(6)-benzyladenine (BA), 2-(4-chlorophenoxy)-2-methylpropanoic acid (CPMP), (4-chlorophenoxy)acetic acid (CPA), rhodanine-N-acetic acid (RAA), and 2,3,5-triiodobenzoic acid (TIBA) significantly increased soluble protein and decreased senescence, measured by leaf light transmission, at CO(2) concentrations below the compensation point in a survival chamber. All compounds except BA significantly decreased transmission values under ambient atmospheric conditions. In statistically significant experiments, applications of 3.49 millimolar CPMP increased net photosynthesis on a leaf area basis by an average of 14.4% at all trifoliolate positions with increases generally requiring response periods of 12 days or longer. RAA at 1.31 and 2.61 millimolar increased net photosynthesis by 19 to 36% following 13-day response periods. CPMP and other compounds tested had no effect upon the CO(2) compensation point after 4- to 8-day response periods. The effects of CPMP and RAA upon net photosynthesis and soluble protein appeared to involve a combined stimulation of protein synthesis and an antisenescent effect. There were no indications that any of the photosynthetic changes observed resulted from direct differential effects upon ribulose bisphosphate carboxylase-oxygenase. The assays for soluble protein and light transmission responded more consistently to the chemicals than did photosynthesis.

Cytomegalovirus infection and chronic hemodialysis

Serologic and virologic studies of cytomegalovirus (CMV), a virus infection often disseminated in immunosuppressed patients, were initiated among hemodialysis patients, home dialysis partners, hemodialysis center personnel, and several groups of patients. No evidence was found of activation or persistence of CMV infections in connection with chronic renal disease or in association with hemodialysis. Evidence of increased CMV activation and/or infection was found among individuals who had re-entered the dialysis program following renal allograft rejection. The data indicate that dialysis personnel and home dialysis partners are not at increased risk for CMV infection. The findings of this study, which contrast with those pertaining to hepatitis B infection, suggest that different mechanisms are responsible for establishing both infection and persistence of CMV and hepatitis B.

Hyperpyrexia due to air-conditioning failure in a nursing home

During the period August 9--13, 1976, 21 of 89 residents of a nursing home in southeastern Florida had sudden onset of fever--temperature greater than 38.1 degrees C (100.6 degrees F) with no accompanying symptoms. Five residents, whose temperatures ranged from 39.4 degrees C (103 degrees F) to 41.3 degrees C (106.4 degrees F), died. No viral or bacterial pathogens were isolated. None of the nursing home's 123 employees and volunteers had similar illness. The air-conditioning system was shut down for repairs from August 9 through August 12, a time when recorded peak temperatures outdoors ranged from 30.6 degrees C (87 degrees F) to 32.2 degrees C (90 degrees F). The only recorded temperature inside the nursing home for that period was 31.7 degrees C (89 degrees F). Laboratory and epidemiologic data were consistent with the theory that the illness was due to hyperpyrexia, secondary to environmental conditions, rather than to an infectious agent. The episode was considered analogous to the nonspecific increased mortality of elderly and chronically ill persons during an urban heat wave. The episode points up the need for prompt recognition and intervention when there is the potential for heat stress in elderly and chronically ill patients. Buildings housing such patients must be designed so that alternative ventilation can be provided when the central air-conditioning system fails.

Energy-linked potassium uptake by mitochondria from wild-type and poky strains of Neurospora crassa

Mitochondria from Neurospora crassa, like mammalian mitochondria, carry out rapid, energy-linked K+ uptake and H+ release in the presence of valinomycin. The maximal rate of K+ uptake was about 1.0 mumol/mg of mitochondrial protein per min and was seen at valinomycin concentrations in the range of 100 to 200 mug per mg of mitochondrial protein and at K+ concentrations of 4 mM or above. Uptake could be supported either by substrate oxidation or by adenosine 5'-triphosphate (ATP), and was inhibited in the former case by antimycin or cyanide, in the latter case by oligomycin, and in both cases by 2,4-dinitrophenol. Mitochondria from the cytochrome-deficient mutant poky carried out substrate-driven K+ uptake at reduced rates, but oligomycin-sensitive, ATP-driven K+ uptake at rates about 60% greater than those shown by wild-type mitochondria. This result is consistent with the recent finding (Mainzer and Slayman 1976) that poky contains elevated amounts of oligomycin-sensitive mitochondrial adenosine 5'-triphosphatase activity.

Variables Affecting the CO(2) Compensation Point

Some factors influencing dark respiration, photorespiration, and photosynthesis were examined for their effect on the CO(2) compensation point (70 mul/l) of detached soybean (Glycine max) leaf discs. A higher compensation point in young leaves decreased to the constant value after leaf expansion and maturation, but increased again during senescence. The compensation point was 40 to 50% higher in plants grown in the summer than in the winter. The compensation point and dark respiration increased with temperatures above 17 C. Below 17 C dark respiration continued to decrease, but the compensation point did not decrease further. Increasing light intensities did not affect the compensation point.The effect of selected chemicals on the compensation point were surveyed. Some buffer components did not greatly alter the compensation point but organic solvents lowered it. Potassium phosphate and pyrophosphate greatly increased it. Inhibitors of photosynthesis increased the compensation point. Hydroxypyridinemethanesulfonate and sodium bisulfite severely inhibited photosynthesis in soybean leaves, stimulated dark respiration, and increased the compensation point.

Varicella gangrenosa due to group A beta-hemolytic Streptococcus

Varicella is usually a well-tolerated disease in normal children. Pyogenic infections involving the skin are the commonest complications and their potential severity is emphasized by our recent experience with two children who suffered from gangrene as a result of cutaneous superinfection with group A beta-hemolytic streptococci. We present the recognition and management of these patients in an effort to reacquaint physicians with this potentially fatal infection.

Hemophilus influenzae b pericarditis in children

Recent experience in the diagnosis and management of Hemophilus influenzae b pericarditis is described in five children. Anterior pericardectomy appears to be the preferred method of surgical drainage because it was associated with a shorter hospitalization than pericardiocentesis or closed or open pericardotomy and removed the risk of recurrent cardiac tamponade and constrictive pericarditis. Countercurrent immunoelectrophoresis of sera and pericardial fluid was used to rapidly identify the etiology of pericarditis in four of four patients tested. The observation that three children appeared to develop pericarditis in the absence of a contiguous infectious focus suggests that bacteremic seeding of the pericardium may be important in the pathogenesis of this disease.

Female homosexuals' concepts of self, men, and women

Twenty-four female homosexuals and 24 female heterosexuals matched for age and education were given the Draw-A-Person Test (DAP) and, on the Gough-Heilbrun Adjective Check List (ACL), were asked to describe themselves, men in general, and women in general. Results indicated that homosexuals, relative to the heterosuxual controls: (a) sexualized their drawings (p smaller than .02) and embellished the female figure more (p smaller than .05); (b) showed no evidence of confusion in gender identity on the DAP or ACL; (c) scored sifnigicantly higher on Autonomy, Change, and Exhibition on the ACL; and (d) scored significantly lower on Abasement, Defensiveness, Deference, Endurance, Order, Personal Adjustment and Self-control on the ACL. It was concluded that the female homosexual may be more independent, changeable, and sexually preoccupied and less well adjusted than her heterosexual counterpart.