The representation of authority: an adolescent viewpoint

It is argued in this paper that participation of young people in society is to a degree a function of their attitudes towards those in authority. More specifically the research reports results from an investigation designed to assess young people's attitudes (n = 2046) to parents, teachers and police taken together as a multivariate representation of authority. The results, at both scale and item level, provide little support for the position often taken in the literature that adolescents are generally anti-authority. On the contrary the evidence points in the opposite direction with favourable attitudes being displayed to all three authority roles but in particular towards police and parents. Some of the complexities inherent in such research are pointed up with attitude to authority, represented as a tripartite dependent vector variable, being seen to vary with individual attributes such as sex and age and contextual variables such as school attended. In general girls exhibit a more favourable attitude to authority than boys, authority relationships weaken with age and organisation of schools in terms of "caring" principals result in a weakening of adult-authority relationships.

Fluid replacement during hypothermia

Hypothermia produces acidosis, depressed cardiac function, hypovolemia and hypotension. This study was designed to examine the cardiovascular dynamics involved with restoration of the hypovolemia before rewarming. Mixed breed splenectomized adult dogs (n = 16) were anesthetized with pentobarbital and cooled to a right atrial temperature of 25 degrees C at a rate of 3 degrees C X h-1. The animals were maintained at 25 degrees C for 6 h and rewarmed at 3 degrees C X h-1. Group 1 was given no fluid, Group 2 was given saline (20% of plasma volume infused in 10 min). 2 h after reaching 25 degrees C and Group 3 received saline just prior to rewarming. The hematocrit was elevated in all groups (p less than 0.05) upon cooling, but did not differ between groups even after saline was given. Cardiac output (Co) at 25 degrees C was 35% of precooled values. Group 2 increased their Q by 15% with fluid and this Q was maintained at higher levels than Groups 1 or 3 for the next 4 h. Plasma volume, heart rate, and cardiac contractility returned to control levels upon rewarming, but Q remained low (less than 10%). The level of Q at the start of rewarming did not affect the final level of Q.

Generation of monoclonal antibodies to a human natural killer clone. Characterization of two natural killer-associated antigens, NKH1A and NKH2, expressed on subsets of large granular lymphocytes

The initial characterization of two monoclonal antibodies directed at antigens selectively expressed on large granular lymphocytes (LGL) is reported in the present paper. These two reagents, anti-natural killer (NK) H1A and anti-NKH2, were obtained following immunization of mouse spleen cells with a cloned human NK cell line termed JT3. In fresh human peripheral blood, both anti-NKH1A and anti-NKH2 selectively reacted with cells that appeared morphologically as large granular lymphocytes. However, complement lysis studies and two color fluorescence analysis demonstrated that some LGL express both antigens and other cells express only NKH1A or NKH2. Functional analysis of these subsets indicated that the population of NKH1A+ cells contains the entire pool of NK active lymphocytes, whereas expression of NKH2 antigen appeared to delineate a unique subpopulation of LGL which, in a resting state, display a low degree of spontaneous cytotoxicity. Expression of NKH1A and NKH2 was also investigated using a series of nine well characterized human NK clones. All NK clones were found to be NKH1A+ and four out of nine also expressed NKH2. These results strongly supported the view that NKH1A is a "pan-NK" associated antigen, and indicated that at least a fraction of cloned NKH2 + LGL are strongly cytotoxic. Anti-NKH1A was shown to have the same specificity as the previously described N901 antibody and was found here to precipitate a 200,000-220,000-mol wt molecule in SDS-polyacrylamide gel electrophoresis (PAGE) analysis. Anti-NKH2 was specific for a structure that migrates at 60,000 mol wt in SDS-PAGE analysis under reducing conditions. Two color immunofluorescence analysis of NKH1A, NKH2, and other NK-associated antigens (Leu7 and B73.1) demonstrated variable degrees of coexpression of these antigens, which confirmed that NKH1A and NKH2 define distinct cell surface structures. Anti-NKH1A and anti-NKH2 appear to be useful reagents for characterizing LGL present in human peripheral blood and for identifying functionally relevant subsets within this heterogeneous population of cytotoxic lymphocytes.

Control of metastases in the Nb rat prostatic adenocarcinoma model

Chemotherapeutic agents, as well as acetyl-salicylic acid, heparin, and indocin, were evaluated in regard to their effect on the rate of metastasis in the androgen-insensitive Noble rat prostate adenocarcinoma system. Acetyl salicylic acid, heparin and indocin were similar to the chemotherapeutic agents cyclophosphamide and adriamycin in reducing the incidence of metastases, but had less effect on tumor volume. In the heparin and indocin groups, the rate of metastases was approximately one half that of the control group (25% vs. 59%). In all three experiments evaluating heparin and indocin, there was a decrease in the number of animals with metastasis compared with control groups.

Overcoming barriers to permanency planning

The authors describe their success with a permanency planning project that emphasized interagency cooperation and worked from the thesis that every child is adoptable if return to the biological family is not possible.

Differential methylation of class I histocompatibility antigen genes in T-cell lines derived from two different types of T-cell malignancies

We have previously shown that two human T-cell lines (HSB and 8402) derived from patients with childhood T-cell ALL (T-ALL) do not synthesize detectable mRNA for HLA-DR alpha. The DR alpha genes in both cell lines are hypermethylated relative to the same genes in T-cell lines infected with human T-cell leukemia virus (HTLV) and derived from patients with adult T-cell leukemia/lymphoma (ATL). These latter cell lines do express HLA-DR alpha-mRNA, as well as HLA-DR surface antigens. We report here that the genes for HLA class I antigens are also highly methylated in the T-ALL T-cell lines relative to the same genes in the ATL T-cell lines, normal peripheral blood T cells, and autologous normal B-cell lines. In spite of substantial differences in the extent of methylation of class I-related genes, no obvious differences exist among these cell types in their levels of expression of HLA-A and -B antigens. The data clearly indicate, however, that the class I and class II components of the major histocompatibility complex are unusually hypermethylated in several T-ALL-derived cell lines, while ATL T-cell lines do not substantially differ in this respect from normal peripheral blood T-cells.

Cell surface antigen expression in newborn cord blood lymphocytes infected with HTLV

Human T cell lymphocyte lines, established from lymphoid tissues from patients with adult T cell malignancies infected with the human T cell lymphoma virus (HTLV), were used in co-culture experiments to infect newborn cord blood lymphocytes (CBL). The infected and non-infected CBL cell lines were typed for HLA alloantigen determinants and tested for cell surface antigens using selected monoclonal antibodies. Infected cord blood lymphocytes showed inappropriate expression of alloantigenic determinants of the HLA-A and -B alleles. The monoclonal antibody 4D12, detecting an antigen common to the HLA-B5 cross-reactive group, was reactive with all infected cultures; this determinant appeared de novo in CBL cells lacking B5 cross-reactive group antigens in the uninfected state, and it increased in density in the infected cultures where the HLA-B5 cross-reactive alloantigens were present in uninfected CBL. HLA-DR was expressed in low levels or not detected on non-infected cultured cord blood lymphocytes and was present on all infected cells. OKT4 positive cells predominated in infected cultures, whereas OKT8 positive cells decreased in number or were absent. The TCGF receptor also increased both in density and in percent positive cells in all infected cell lines. The results suggest that HTLV may be tropic for a subset of T cells expressing mature T cell markers and that viral infections directly affect expression of cell surface antigens controlled by the human major histocompatibility complex (MHC).

Cell surface antigen expression in newborn cord blood lymphocytes infected with HTLV

Human T cell lymphocyte lines, established from lymphoid tissues from patients with adult T cell malignancies infected with the human T cell lymphoma virus (HTLV), were used in co-culture experiments to infect newborn cord blood lymphocytes (CBL). The infected and non-infected CBL cell lines were typed for HLA alloantigen determinants and tested for cell surface antigens using selected monoclonal antibodies. Infected cord blood lymphocytes showed inappropriate expression of alloantigenic determinants of the HLA-A and -B alleles. The monoclonal antibody 4D12, detecting an antigen common to the HLA-B5 cross-reactive group, was reactive with all infected cultures; this determinant appeared de novo in CBL cells lacking B5 cross-reactive group antigens in the uninfected state, and it increased in density in the infected cultures where the HLA-B5 cross-reactive alloantigens were present in uninfected CBL. HLA-DR was expressed in low levels or not detected on non-infected cultured cord blood lymphocytes and was present on all infected cells. OKT4 positive cells predominated in infected cultures, whereas OKT8 positive cells decreased in number or were absent. The TCGF receptor also increased both in density and in percent positive cells in all infected cell lines. The results suggest that HTLV may be tropic for a subset of T cells expressing mature T cell markers and that viral infections directly affect expression of cell surface antigens controlled by the human major histocompatibility complex (MHC).

Remission of acute myelogenous leukemia in elderly patients with prior refractory dysmyelopoietic anemia

Refractory dysmyelopoietic anemia (RDA) is a myeloproliferative disorder usually of elderly patients which often evolves into acute myelogenous leukemia (AML). AML in such patients is usually considered untreatable with standard aggressive chemotherapy in part because these patients are often elderly, but primarily because of the concern that the bone marrow of these patients no longer has a residual stem cell to repopulate the bone marrow following chemotherapy-induced aplasia. The authors treated three patients (ages 72, 69, and 62 years, respectively) with intensive chemotherapy after RDA evolved into AML. Each patient had been pancytopenic for 3 to 15 months prior to their transition to AML. At the onset of therapy for AML, all were severely pancytopenic with greater than 50% myeloblasts in the bone marrow. All patients had bone marrow aplasia by day 14 after chemotherapy with a complete bone marrow remission and normal peripheral counts by day 26. These data suggest that intensive chemotherapy of AML with prior RDA may result in complete bone marrow remission.

Cell lines producing human T-cell lymphoma virus show altered HLA expression

Human T-cell leukaemia/lymphoma virus (HTLV) can be identified in fresh and cultured T-lymphocytes from patients with adult T-cell malignancies. HLA typing of the peripheral blood lymphocytes and cultured cell lines from the patient from which the virus was originally isolated suggested the expression of additional HLA-A and -B locus antigens on the HTLV positive cultured T-cells that were not present on the EBV transformed B-cell line or on the peripheral blood lymphocytes. Peripheral blood lymphocytes (PBLs) and T-cell lines established from patients and cord blood lymphocytes, infected with virus by co-culture with T-cell lines, were typed for HLA antigens with alloantisera and in addition tested for reactivity with a monoclonal antibody (4D12) which recognizes a polymorphic HLA class-I antigen. In all HTLV positive cells, with demonstrable provirus replication, altered HLA alloantigen expression was observed. This may be explained by the observations reported in the accompanying paper which shows homology between the envelope gene region of HTLV and the region of an HLA-B locus gene which codes for the extracellular portion of a class I histocompatibility antigen.

Generation of an HLA-restricted cytotoxic T cell line reactive against cultured tumor cells from a patient infected with human T cell leukemia/lymphoma virus

Lymphocytes from a patient who had an unusually long survival after therapy for a human T cell leukemia/lymphoma virus (HTLV)-associated T cell lymphoma were stimulated in vitro with an autologous tumor cell line, and the generation of cytotoxic T lymphocytes (CTL) was studied. CTL generated were directed against autologous (HTLV-associated tumor cells. These propagated CTL were OKT3+, OKT4-, and OKT8+. The cytotoxic activity required target tumor cells that were infected with HTLV and also expressed histocompatibility antigens in common with the patient, suggesting a major histocompatibility complex-restricted associative recognition of target antigens expressed on the tumor cell membrane.

Comparison of susceptibilities of anaerobic bacteria to cefmenoxime, ceftriaxone, and other antimicrobial compounds

The minimal inhibitory concentrations of cefmenoxime, cefotaxime, cefoxitin, ceftriaxone, chloramphenicol, clindamycin, and moxalactam were determined by agar dilution for 202 clinical isolates of anaerobic bacteria. Cefoxitin and moxalactam were the most active among the cephalosporin-like compounds.

Amyl nitrite may alter T lymphocytes in homosexual men

To evaluate the recent outbreak of Kaposi's sarcoma (KS) and opportunistic infections in homosexual men, clinical, virological, and immunological data on two homosexual men with KS and on fifteen healthy homosexual volunteers were collected. Both KS patients had regularly used amyl or butyl nitrite (AN); they had low helper/suppressor (H/S) T-lymphocyte ratios before chemotherapy and high titres of antibody against cytomegalovirus (CMV). Eight of the fifteen volunteers were regular AN users; seven of the eight had low H/S ratios due to larger than normal numbers of OKT8-positive suppressor cells and smaller numbers of OKT4-positive helper cells. In all eight AN users the fluorescence profile obtained with monoclonal antibody 9.6 (which detects the sheep E-rosette receptor) was bimodal, indicating a subpopulation of T cells with increased receptor density. A similar pattern was observed when OKT8, the antibody which detects cytotoxic suppressor cells, was used. Two of the seven men who did not use AN had abnormal fluorescence with reagent 9.6, and one of these also had a low H/S ratio. CMV-antibody titres were persistently high in fourteen of the fifteen healthy men, but the titres were not related to AN use of T-cell abnormalities. The data suggest that nitrites may be immunosuppressive in the setting of repeated viral antigenic stimulation and may contribute to the high frequency of DS and opportunistic infections in homosexual men.

A survey of referral problems to a psychiatric preschool program: patient characteristics and therapeutic considerations

This study provides a detailed account of the nature of referral problems found in a consecutive series of 90 cases admitted to a psychiatric preschool treatment program. The characteristics of the sample, including age, sex, and ordinal position of the children are described. The type of presenting problems and such features of the child as speech and language function and intelligence are included as well. The characteristics of the parents are also included, such as their social class and their marital and psychiatric status.

These results are understood in the context of a developmental-interactional frame of reference, such that four categories of problems can be identified: 1) those children with organic/constitutional difficulties; 2) those children with mild developmental difficulties that put them in conflict with their parents’ or teachers’ expectations; 3) those children whose problems are reactive to family conflict and marriage breakdown; and 4) those marginally coping parents who decompensate when their preschooler reactivates unresolved internal conflicts of their own, which are then projected onto the child who becomes the identified patient.

The nature and details of the treatment program are described with particular reference to the four categories of problems identified. The unique advantage of a program such as this, and the difficulties providing service and continuity of care for these children and families are highlighted. The importance of an integrated and comprehensive approach which coordinates the educational, social and psychiatric services is emphasized if preventive psychiatry is to retain its meaning and fulfill its mandate.

Histocompatibility alloantigens in psoriasis and psoriatic arthritis. Evidence for the influence of multiple genes in the major histocompatibility complex

The frequency of HLA-A, B, and Cw antigens as well as the antigens expressed preferentially on B cells and monocytes (DRw and Ia-like) was examined in a normal population and two related disease populations, psoriasis and psoriatic arthritis. HLA antigens distinguishing the two disease populations were found. Psoriatic patients demonstrated an increase in frequency of HLA-A1, B17, and B13. Patients with psoriatic arthritis demonstrated an increased frequency of HLA-A26, B38, and DRw4. Antigens showing a common increase in frequency in the two disease populations were HLA-Cw6, DRw7, and Ia744. These results demonstrate genetic differences as well as similarities in the two populations of patients with the common clinical feature of psoriasis. In addition to the above analysis, we examined the association of individual alloantigens elevated in frequency in the diseased population. These same alloantigens were examined for association in the normal population. This analysis revealed HLA antigen associations in the two disease groups that differed from the association of several antigens in the normal population. The results suggest that at least two genetic factors, one mapping in the HLA-A, C-B region and one mapping in the HLA-B-DRw region are associated with the disease states. Thus, multiple factors controlled by genes in the major histocompatibility complex appear to contribute to the disease entities under investigation.

Ultrasound in the evaluation and diagnosis of jaundice

Our experience in the evaluation and diagnosis of jaundice by ultrasound in a consecutive series of patients examined in the past year is reported. A final diagnosis is available in 49 patients with obstructive jaundice and 41 patients with nonobstructive jaundice. The accuracy of separation into these two groups is 97% in this series. We would like to stress the value of ultrasound as a complete investigation in many jaundiced patients. In this series a full diagnosis of the cause of jaundice was achieved in 58% of patients.

The biological suppression of malaria: an ecological and nutritional interrelationship of a host and two parasites

The interrelationship of malaria and severe ascariasis was studied in Anjouan children with a previously described syndrome of enlarged parotids, localized forehead edema, heavy infestation with Ascaris lumbricoides, and unusual freedom from malaria. After treatment of 37 such children with the ascaricide piperazine, 35 had resolution of parotid enlargement and forehead edema, but 19 developed attacks of malaria. Children treated with placebo had neither resolution of clinical findings nor attacks of malaria. We propose that suppression of the malaria in these children is a nutritional consequence of severe ascariasis and may represent an ecological balance for optimum co-survival of the host and the two parasites.

Nonpenetrating thoracic injuries

In patients with nonpenetrating thoracic trauma, the rib fractures and other chest wall lesions may distract the physician from dangerous internal injuries in the chest or abdomen which may not be noted unless looked for very carefully. Early vigorous correction of any ventilatory problem is essential, particularly if there is any evidence of impaired tissue perfusion. Shock is frequently due to extrathoracic injuries, particularly intraabdominal bleeding. The flail associated with multiple rib fractures may seem mild initially, but severe underlying pulponary contusion and/or associated extrathoracic injuries make early ventilatory assistance extremely important. Rupture of the thoracic aorta should be suspected in rapid deceleration injuries, but is often not considered unless there is widening of the superior mediastinum on hte chest x-ray. Aortography to confirm the aortic tear should be done if time permits, and early repair of the injury provides the best results.