Predicting success in psychiatric training for foreign medical graduates: II. Patterns in course

Faculty ratings of 22 foreign medical graduates ('FMGs'), all of whom entered psychiatric residency training at the University of Missouri-Columbia from 1966 through 1973, were compared with those of a similar group of North American medical graduates ('AMGs'). An on-going evaluation programme provided data for a variety of parameters ranging from 'theoretical knowledge' to 'clinical skills'. Results indicated that in most of performance the median FMG started at a level substantially lower than that of the median AMG and very slowly caught up. When achievement criteria were utilized it became apparent that, at least by the third year of training, 'superior' FMGs could equal or surpass the median performance of 'superior' AMGs, whereas 'marginal' residents, whether foreign or native-born, seldom attained even competence in most major spheres of functioning. Implications of these findings and those in related studies are discussed.

Congenital anomaly of the odontoid in children. A report of four cases

The embryologic origins of congenital abnormalities of the odontoid process are reviewed. Four cases of odontoid dysgenesis in childhood are presented. All of our cases were associated with a head injury, which subsequently led to the diagnosis. Pain was the most common presenting complaint in our patients. Decreased cervical mobility was the most consistent physcial finding. There was no major neurological defect implicating spinal cord compression in any of our patients. This is not true of adults with congenital abnormalities of the odontoid, particularly those with atlantoaxial instability. The diagnosis of odontoid dysgenesis is a radiographic one. Flexion-extension films, tomograms and cineradiograms are often required to make the diagnosis. C1-C2 subluxation, either anterior or posterior is often found. Prompt posterior cervical fusion is recommended as the treatment of choice.

Factors associated with attempted suicide among hospitalized depressed patients

An attempt was made to identify background, sociodemographic and clinical variables which are associated with attempted suicide in depression. Within a sample of 308 depressed psychiatric inpatients, suicide attempters were younger than non-attempters and were identified by a pattern of chronic interpersonal maladjustment reflected clinically in withdrawal from social contact and the display of hostility or irritability toward others.

Myelination of brain in experimental hypothyroidism. An electron-microscopic and biochemical study of purified myelin isolates

Myelin development has been studied in the neonatally hypothyroid rat brain by isolation and characterization of purified myelin preparations. The hormone deficiency results in a suppression of compact myelin formation and the persistence of a lighter possibly pro-myelin fraction. The appearance of myelin basic protein was markedly delayed in the hormone-deficient animals and this effect on the basic protein moiety may be responsible for the delayed myelinogenesis.

Hyperlipoproteinemia in occlusive cerebrovascular disease

The distribution of occlusive atherosclerotic lesions in the aortocranial circulation as determined by arteriography was correlated with results of plasma lipid and lipoprotein determinations of patients with symptoms and signs of cerebrovascular disease. The incidence of hyperlipoproteinemia in the total study population was 31.8%. The frequency of hyperlipoproteinemia was signigicantly higher in patients with atherosclerotic lesions limited to extracranial (51%) and intracranial major vessels (44.2%) when compared to the total number of patients and patients with only intracranial small-vessel disease (P less than .05). Type IV hyperlipoproteinemia was the most common abnormality (extracranial group, 42% type IV, 9% type II; intracranial major-vessel group, 35.8% type IV, 8.4% type II). Patients with intracranial small-vessel disease had the lowest frequency of hyperlipoproteinemia (14.2%). The frequency of hypertension with or without hyperlipoproteinemia was higher in patients with intracranial small-vessel disease (P less than .01).

Immunological studies in acute myeloid leukaemia: PHA responsiveness and serum inhibitory factors

Sera from 16 of 20 patients with AML at some stage of the disease inhibited the in vitro PHA transformation of normal lymphocytes assessed by measuring the rate of DNA synthesis after 67-70 hours; 42% of pretreatment sera were inhibitory. Inhibitory activity was overcome at PHA concentrations 2-3 times greater than the concentration which allowed maximum discrimination between NHS and leukaemia sera.PHA transformation of washed lymphocytes obtained from AML patients before treatment and when receiving induction or consolidation (cytoreductive) chemotherapy was reduced only when cultures contained a high proportion of primitive cells. Even in primitive cell contaminated cultures significant responses to PHA could be measured if conditions were modified to prevent increasing acidity.Reports of reduced in vitro immunological reactions in pretreatment and poor prognosis patients may therefore be due to the presence of primitive cells in culture, and in treated patients to the failure of chemotherapy to reduce the circulating primitive cell count. Serum inhibitory factors may have a significant immunosuppressive effect in vivo, but the accurate assessment of the role of immune mechanisms in AML should attempt the measurement of specific immunity.

Successful use of oral diazoxide in the treatment of severe toxaemia of pregnancy

Treatment with oral diazoxide for periods of 4 to 10 weeks in hospital allowed adequate control of hypertension with continuation of fetal growth in four patients with severe toxaemia. Two were insulin-dependent diabetics and one of these suffered from renal failure. In all patients albuminuria diminished markedly, while the fluid retention was controlled with frusemide. Three pregnancies were successfully terminated by lower segment caesarean section and in the remaining case vaginal delivery resulted in the birth of a healthy baby. Control of blood sugars presented no problems in the diabetic patients. Only minimal adjustments of insulin dosage were required. One of the non-diabetic patients developed mild hyperglycaemia which responded to tolbutamide. The babies, ranging in age from 5 to 12 months, have continued to thrive.

Transfer of thymidine kinase to thymidine kinaseless L cells by infection with ultraviolet-irradiated herpes simplex virus

L cells lacking thymidine kinase (TK) activity (Ltk(-) cells) have been stably transformed to a TK-positive phenotype by infection with ultraviolet-irradiated herpes simplex virus (HSV-UV). The highest frequency of the Ltk(-) to Ltk(+) transformation observed in these experiments was approximately 10(-3), whereas no measurable transformation was observed (less than 10(-8)) in the absence of HSV-UV infection. Cell lines of HSV-transformed Ltk(+) cell lines contain 7 to 24 times as much TK activity as do the parental Ltk(-) cells, and they have been maintained in culture for a period exceeding 8 months. The kinetics of thermal inactivation of the TK activity derived from an Ltk(+) HSV-transformed cell line and the TK activity from Ltk(-) cells lytically infected with infectious HSV are similar. Both of these TK activities are much more thermolabile than the TK activity present in wild-type L cells. A mutant strain of HSV which does not induce TK activity during lytic infection does not cause the Ltk(-) to Ltk(+) transformation. These data suggest that either an HSV TK gene has been transferred to Ltk(-) cells or that an HSV gene product has caused the expression of a previously repressed cellular enzyme.

The pathological findings in fatal craniospinal injuries

✓ A series of 50 fatal cases of craniospinal injury were reviewed with particular attention to the pathological findings at the craniospinal junction. There was marked tendency for the spinal cord to be damaged in the upper cervical segments, whereas disc injuries predominated in lower cervical segments. The vertebral artery was rarely involved. The lateral ligamentous structures were often damaged, while the transverse ligaments of the odontoid were spared. Rupture of muscles was rare, although hemorrhage into muscles was common.

Size estimation in schizophrenia: some additional controls

Size estimation was studied in 14 hospital aides and the following four groups of 14 male schizophrenics: acute good premorbid paranoid, acute poor premorbid nonparanoid, chronic good premorbid paranoid, and chronic poor premorbid nonparanoid. Unlike previous studies: (1) Ss were at optical infinity from the stimuli to eliminate possible micropsia or macropsia, and (2) stimuli were viewed with an artificial pupil. Contrary to previous findings, no significant differences occurred among the groups in level of size estimation. As in previous studies, the thematic content of the stimuli influenced size-estimation levels but this variable did not interact with subject classification.

Determination of iodine concentration and distribution in rat thyroid follicles by electron-probe microanalysis

The concentration and the distribution of iodine in various sized follicles of rat thyroid glands have been analyzed by electron-probe microanalysis. The results of the iodine analysis were grouped according to uncorrected lumen diameter size. No significant differences in iodine concentration were observed among the various size categories. When the results for all follicles from a given sample were pooled, the standard error of the mean was approximately 4%. Usually 40-50 follicles per animal were analyzed. The concentration of iodine ranged from 0.9 to 2.1% by weight among individual animals. Scanning pictures and step-scan analysis showed the iodine distribution to be quite uniform across the colloid area. Several techniques of sample preparation were used; they produced no significant differences in the iodine concentrations observed. Sodium concentration, also determined in all samples, was found to vary from 2 to 9% by weight. Because of the mobility of the sodium ion, its distribution was greatly affected by the method of sample preparation. The technique that best preserved the natural chemistry of the sample was that of freezing the tissue, sectioning, and then freeze-drying.

Crying in depression

In making a diagnosis between psychotic and neurotic depression, characteristic signs and symptoms are usually looked for. Although there is much controversy in the literature in respect to this difference, particularly since Lewis's work in 1934, nevertheless one commonly observes that when people are sad they cry. We would expect, therefore, that this would apply also in depressions. Yet, in our survey of the journal literature and such major textbooks as Mayer-Gross, Slater and Roth's Clinical Psychiatry, Arieti's American Handbook of Psychiatry, and Freedman & Kaplan's Comprehensive Textbook of Psychiatry, the authors fail to include crying as a symptom of depression.

Intense vacuum ultraviolet atomic line sources

Intense atomic lines (O, N, S, C, Br, Cl, H, Se, Kr) have been produced by microwave excitation of mixtures of various gases in helium under flow conditions. The intensities generally obtained are greater than 10(14) quanta/sec and are suitable for atomic emission studies and as photochemical light sources in the vacuum uv. Conditions for producing these high purity line sources are discussed.