Health effects of caregiving: the caregiver health effects study: an ancillary study of the Cardiovascular Health Study

We propose that two related sources of variability in studies of caregiving health effects contribute to an inconsistent pattern of findings: the sampling strategy used and the definition of what constitutes caregiving. Samples are often recruited through self-referral and are typically comprised of caregivers experiencing considerable distress. In this study, we examine the health effects of caregiving in large population-based samples of spousal caregivers and controls using a wide array of objective and self-report physical and mental health outcome measures. By applying different definitions of caregiving, we show that the magnitude of health effects attributable to caregiving can vary substantially, with the largest negative health effects observed among caregivers who characterize themselves as being strained. From an epidemiological perspective, our data show that approximately 80% of persons living with a spouse with a disability provide care to their spouse, but only half of care providers report mental or physical strain associated with caregiving.

Interpretative inferences when reading about emotional events

In three experiments we investigated the extent to which individuals with high or low levels of anxiety about interviews made emotionally-congruent interpretative inferences while reading descriptions of a relevant ambiguously-threatening event (being interviewed for a job). Evidence was found to support the hypothesis that groups varying in self-reported concern about the described event differed in the interpretations that they made while reading. Taken together, the results of the three experiments are consistent with the conclusion that non-anxious individuals infer positive outcomes to an ambiguous event, while highly anxious individuals do not. We suggest that these results have implications for cognitive processes that could maintain anxiety in real life.

Evidentiation of paramyosin (Sm-97) as a modulating antigen on granulomatous hypersensitivity to Schistosoma mansoni eggs

A Schistosoma mansoni adult worm anionic fraction (PIII) has previously been shown to protect mice against challenge infection and to reduce pulmonary and hepatic granulomatous hypersensitivity. Serum from PIII-immunized rabbit was used to screen a lambda gt11 cDNA library from S. mansoni adult worm in order to identify antigens capable of modulating granulomatous hypersensitivity. We obtained four clones with 400 (Sm-III.11), 900 (Sm-III.16), 1100 (Sm-III.10) and 1300 (Sm-III.12) bp of length. All clone-specific antibodies were able to recognize most of the PIII components. The sequence analysis showed that these clones presented high homology with S. mansoni paramyosin (Sm-97). These findings ascribe a new function to this antigen with an important role in modulation of granulomatous hypersensitivity to S. mansoni eggs.

Quantitative assessment of cerebral blood flow in patients with Alzheimer's disease by SPECT

This study evaluated an automated analysis of SPECT brain imaging in patients with Alzheimer's disease (AD).

METHODS

Patients [n = 81; mean age, 69.9 +/- 10.6 yr (mean +/- s.d.)] with a clinical diagnosis of probable AD (NINCDS-Alzheimer's Disease and Related Disorders Association criteria) underwent 99mTc-ethyl cysteine dimer SPECT imaging. After imaging registration and data extraction using three-dimensional stereotactic surface projections, a pixel-wise comparison of ethyl cysteine dimer uptake was performed using a reference database of 10 cognitive intact controls of comparable age.

RESULTS

When individual cases were compared to the normal database, temporo-parietal regional cerebral blood flow (rCBF) abnormalities across different levels of dementia severity were clearly depicted on pixel-wise Z-score images. The rCBF reduction in cortical association areas showed a significant correlation with an overall level of cognitive decline, as assessed by the Mini Mental State Examination and by the cognitive section of the Cambridge Mental Disorders of the Elderly Examination. In addition, there were significant region-specific correlations between left temporo perfusion deficit and language performance and between right parietal rCBF reduction and praxis.

CONCLUSION

These results indicate that this observer-independent analysis of SPECT data enables objective and semiquantitative assessment of the magnitude and extent of cortical perfusion abnormalities in patients with AD.

Induction of protective immunity and modulation of granulomatous hypersensitivity in mice using PIII, an anionic fraction of Schistosoma mansoni adult worm

This study was performed in order to define Schistosoma mansoni antigens that are able to function as modulator agents in the granulomatous hypersensitivity to parasite eggs in BALB/c and C57BL/6 mice. A fraction of S. mansoni, designated PIII, derived from adult worm antigen preparation (SWAP) was obtained using anion-exchange chromatography on an FPLC system. Immunization of mice with PIII in the presence of Corynebacterium parvum and Al(OH)3 as adjuvant induced an immune response in this animals as determined by ELISA and spleen cell proliferation assays against S. mansoni antigens SEA, SWAP and PIII. In addition, PIII caused a significant degree of protection against a challenge infection in immunized mice as observed by the decrease on worm burden recovered from the portal system. We also showed that PIII profoundly inhibited the vigorous anamnestic granulomatous response to eggs in the liver and lungs. This suppression correlated with a significant decrease in granuloma size. From these results we conclude that the PIII preparation contains antigens that can mediate protective anti-parasite immunity and downregulate granulomatous hypersensitivity to S. mansoni eggs.

Characterization of Schistosoma mansoni 44.7/56.8 kDa egg antigens recognized by human monoclonal antibodies which induce protection against experimental infection and proliferation of peripheral blood mononuclear cells from schistosomiasis patients

We described here the characterization of Schistosoma mansoni egg antigens recognized by human monoclonal antibodies B10 (HmAb-B10) and D5 (HmAb-D5). SDS-PAGE and Western blot analysis revealed that these monoclonals recognized two antigens of M W 44.7/56.8 kDa, with pI of 7.0 and 7.8, respectively. The passive transfer of B10 and D5 induced a significant protection of 48% and 54% in Balbic mice. Results of in vitro cytotoxicity assay showed that both monoclonals were able to kill schistosomula in the presence of rabbit complement. These monoclonals mediated 48% and 74% of schistosomula cytotoxicity, respectively. Egg antigens were purified by affinity chromatography using monoclonal antibodies B10 and D5. Treatment of purified antigens with periodate, galactose oxidase and trifluoromethane sulphonic acid did not prevent binding by B10 and D5 in ELISA assay. However, the treatment with protease K and 2-mercaptoethanol affects the antibodies binding, showing that the HmAbs B10 and D5 recognize polypeptide epitopes. Vaccination of mice with these antigens in Freund's adjuvant induced 43% reduction in worms burden after challenge with S. mansoni cercariae. In vitro blastogenesis assays with peripheral blood mononuclear cells from patients infected with S. mansoni revealed that purified antigens were able to induce significant cell proliferation.

[Occurrence of immune hyperthyroidism after radioiodine therapy of autonomous goiter]

AIM

The goal of the study was to examine the prevalence of Graves' disease following I-131 treatment of autonomous goiter with special regard to pretreatment scintigraphic patterns.

PATIENTS AND METHOD

Pre- and posttreatment in-vitro and in-vivo parameters were studied in 375 consecutive patients treated with I-131 therapy for nodular or diffuse autonomous goiter. All patients included were within ambulant control for at least 2.5 months following treatment. According to the pretreatment Tc-99m pertechnetate scan 59% (220/375) had multifocal (MF), 23% (86/375) unifocal (UF), 10% (38/375) mixed focal-disseminated (FD) and 8% (31/375) disseminated (D) scintigraphic patterns.

RESULTS

In 93.9% (352/375), the autonomous tissue was totally, in 2.1% (8/375) partially and in 1.6% (6/375) insufficiently eliminated. In 2.4% (9/375) a relapse of hyperthyroidism was observed 2 to 10 months following I-131 therapy. In 8 patients a relapse of hyperthyroidism was accompanied or followed by an elevation of the previously non-elevated TSH-receptor antibody (TRAb) level and in 1 patient by an TRAb increase to the upper borderline range implicating Graves' disease. With the prevalence of Graves' disease following I-131 therapy a statistically significant difference in pretreatment Tc-99m pertechnetate scintigraphic patterns was found: 0% of unifocal (0/86) or multifocal (0/220), however 18% (7/38) of focal-disseminated and 7% (2/31) of disseminated scintigraphic patterns. From the 366 patients without relapse of hyperthyroidism 2 (MF) had elevated pre- and posttreatment TRAb levels and 3 (D) had elevated TRAb levels for the first time after I-131 therapy.

CONCLUSION

There is a low overall prevalence (2.4%) of Graves' disease following I-131 therapy for nodular or diffuse autonomous goiter. However, the prevalence of posttreatment Graves' disease is highly dependent upon pretreatment scintigraphic patterns exhibiting focal-disseminated or disseminated patterns.

Reduction of regional cerebral blood flow and cognitive impairment in patients with Alzheimer's disease: evaluation of an observer-independent analytic approach

The aim of the study was to evaluate an observer-independent semiquantitative analysis of brain imaging by single-photon emission computed tomography (SPECT) in patients with Alzheimer's disease (AD). Patients (n = 45, mean age 70 +/- 11 years) with a clinical diagnosis of AD according to NINCDS/ADRDA criteria were examined by 99mTc-ethylcysteine dimer SPECT. Following anatomic normalization and data extraction using three-dimensional stereotactic surface projection, a pixelwise comparison of ECD uptake was performed with the reference values of 10 cognitive intact controls of comparable age. The global relative decrease of cerebral blood flow in cortical association areas showed a significant inverse association with the overall level of cognitive functioning as assessed with the Mini Mental State Examination and with the cognitive section (CAMCOG) of the Cambridge Mental Disorders of the Elderly Examination. There were significant region-specific associations between left temporoparietal perfusion deficit and language performance and between right temporoparietal regional cerebral blood flow reduction and praxis. The results suggest that this observer-independent analysis of SPECT data provides a valid assessment of the pattern and severity of cortical perfusion abnormalities in patients with AD.

[Clinical aspects and histopathology of caruncular tumors]

BACKGROUND

Histologically the lacrimal caruncle represents a transition zone between the conjunctiva and the skin containing cutaneous, conjunctival and lacrimal elements. This accounts for a variety of histopathological changes.

METHODS

We conducted a retrospective study on the histopathological findings of 65 caruncular lesions which were referred for excisional biopsy between 1974 and 1995 to the Department of Ophthalmology at the University of Heidelberg. The age of the patients ranged from 10-87 years (mean 42 +/- 18.2).

RESULTS

Histopathologic diagnoses included 29 (45%) nevi, 15 (23%) papillomas, 7 (11%) chronic inflammatory lesions and 4 (6%) epidermoid cysts. In addition, 4 (6%) semimalignant and malignant tumours were found including one basalioma, one squamous cell carcinoma and two Kaposi-sarcomas. Among the remaining 8% a dermoid cyst, an accessory lacrimal gland with a retention cyst, an epithelial implantation cyst, a teleangiectatic granuloma and an oncocytoma were diagnosed.

CONCLUSION

These findings suggest that malignant caruncular lesions are rare, however excisional biopsy appears prudent in order to establish the histological diagnosis.

Temporal relationship between Uniplant insertion and changes in cervical mucus

This study was undertaken to determine the time required by a single implant containing nomegestrol acetate to affect cervical mucus production and sperm penetration in women. All subjects were investigated and, if necessary, treated for any kind of cervicitis or vaginitis prior to starting cervical mucus study. The subjects had not used hormonal contraception for at least three months prior to investigation. They were counseled to use condoms during this study and also to refrain from intercourse during the period of cervical mucus sampling. Follicular development and endometrial thickness were analyzed by transvaginal sonography. Cervical mucus examination, sperm penetration test, and transvaginal sonography were performed during the control cycle and during the first cycle of Uniplant use. Blood samples were taken for the measurement of estradiol, LH, and progesterone. Cervical mucus and sperm penetration tests were evaluated according to the World Health Organization (WHO) criteria. In the treated cycle, when cervical mucus reached a score of 8-10, Uniplant was inserted, independent of the day of the cycle. Cervical mucus was then collected at 0, 4, 8, 12, 24, 48, and 96 h later until a marked change in volume, consistency, ferning spinnbarkheit, and cellularity was observed. All samples were also used for sperm penetration test. Preovulatory estradiol and LH peak decreased significantly compared to pre-implant insertion. Progesterone levels were within the normal limit. Cervical mucus and sperm penetration tests were not affected by Uniplant in the first 12 h. Twenty-four hours after Uniplant insertion, cervical mucus and sperm penetration tests were affected in 70.6% of the women. Forty-eight hours after implant insertion, the women were affected. Follicular rupture occurred in the majority of the women 48 h after implant insertion. Based on these results, it is possible to conclude that Uniplant can affect estradiol and LH preovulatory peaks and disrupt the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted in the preovulatory phase.

[Is the elimination of osteosarcoma cells with intraoperative "mesh autotransfusion" and leukocyte depletion filters possible?]

Intraoperative autotransfusion is contraindicated in cancer surgery because of the possible risk of systemic tumor spread. The aim of the present study was to investigate whether a cell saver in combination with a white blood cell depletion filter can remove osteosarcoma cells.

METHODS

A defined number of osteosarcoma cells from an established cell line were added to red cell concentrates and Ringer solution. The tumor cell concentration was 1000/ ml in the first five experiments, 7111/ml in test no. 6, 1667/ml in test no. 7 and 167/ml in test no. 8. Following thorough mixing, each unit was processed separately by a cell saver (DIDECO BT 795/P) in its normal operation mode to produce a red cell concentrate. This red cell concentrate was filtered using a leukocyte depletion filter (PALL BPF 4). Samples were taken before and after processing with the autotransfuser and after filtration with the white cell depletion filter. Cytospin specimens from all samples were examined for osteosarcoma cells by three different methods (Papanicolaou stain, Vimentin antibodies, DNA analysis).

RESULTS

After processing with the autotransfuser, tumor cells were identified in the red cell concentrate. No osteosarcoma cells were evident after the combined use of cell saver and leukocyte depletion filter.

CONCLUSION

The sole use of the autotransfuser DIDECO BT 795/P during osteosarcoma surgery is not recommended because of the potential danger of retransfusion of malignant cells. In combination with the leukocyte depletion filter PALL BPF 4, no osteosarcoma cells were identified in the red cell concentrate. Since the adhesiveness of tumor cells from established cell lines may be different from that of tumor cells in the intraoperative salvaged blood, further studies with blood from the surgical field are necessary to determine the efficacy of white cell depletion filters to eliminate osteosarcoma cells.

Characterization of fractionated Schistosoma mansoni soluble adult worm antigens that elicit human cell proliferation and granuloma formation in vitro

Soluble adult worm antigens (SWAP) of Schistosoma mansoni were fractionated by fast protein liquid chromatography (FPLC) system, using Q-Sepharose anion-exchange resin, in order to characterize antigenic fractions that may elicit cell responses in human schistosomiasis. SWAP fractions were eluted by 20 nM Tris-HCl solution (pH 9.6) with an increasing gradient of 1 M NaCl. The FPLC system was able to resolve 6 fractions, enumerated I to VI, according to the NaCl gradient. The analysis of each fraction on SDS-PAGE showed that fractions I to IV were constituted by multiple protein bands with M, ranging from 21 to > 200 kDa. Large amounts of nucleic acids were evidenced in fractions V and VI, as revealed by ethidium bromide staining of agarose electrophoresis gels. Using ELISA, it was shown that sera from chronic schistosomiasis patients contained antibodies that recognized antigens in practically all fractions. Studies were designed to investigate the capacity of these fractions to induce cell proliferation and granuloma formation. It was demonstrated that fraction III stimulated significant proliferative response of peripheral blood mononuclear cells (PBMC) from chronic schistosomiasis patients. However, fraction III coupled to polyacrylamide beads induced small granuloma formation in vitro, whereas beads coated with fractions I, II and V were able to induce significant granuloma reactions.

Effects of a single contraceptive Silastic implant containing nomegestrol acetate on ovarian function and cervical mucus production during 2 years

OBJECTIVE

To study the mechanism of action of Uniplant (South to South Corporation in Reproductive Health, Salvador, Brazil), a single Silastic capsule containing nomegestrol acetate (Lutenyl, Theramex, France) in women during 2 years.

DESIGN

Comparison between the hormonal levels, follicular development, cervical mucus (CM) production, and endometrial thickness in the menstrual cycle before implant insertion and at 1, 6, 12, 18, and 24 months after implant insertion.

PARTICIPANTS

A total of 15 women of reproductive age were enrolled for the 1st year of use. Twelve of these women continued for a 2nd year of Uniplant use.

MAIN OUTCOME MEASURES

Hormonal plasma levels were measured in control cycles and at 1, 6, 12, 18, and 24 months of Uniplant use. Cervical mucus, follicular development, and endometrial thickness also were evaluated.

RESULTS

In this study, Uniplant blocks ovulation in 86 percent of cycles studied. Disturbances in follicular growth were observed also. Cervical mucus was scanty and viscous in all women during this study. Endometrial thickness was <8 mm in all cycles studied.

CONCLUSION

This study shows that Uniplant is a long-acting contraceptive that probably acts at the hypothalamic-pituitary levels, on the ovary, on CM production, and on the endometrium. These properties suggest the use of Uniplant as a contraceptive agent, especially if one considers the lack of androgenic and metabolic effects and the maintenance of periodic bleeding similar to menstruation.

[Turner's syndrome and isoforms of LH and FSH. Value of polyclonal enzymatic techniques]

BACKGROUND

The glycoproteic hormones, LH and FSH, circulate under heterogenous molecular forms, the isoforms. The more acidic isoforms of FSH are found in hypogonadic patients and a displacement towards the basic forms is observed during substitutive treatment.

CASE REPORT

A 13 year-old girl with Turner syndrome was examined for pubertal delay. Ultrasonography failed to see both ovaries and endocrine investigations showed a type P1 response (LH-RH test using immunological method). Control of hormonal levels by a polyclonal immunoenzymatic method confirmed primary hypogonadism.

CONCLUSIONS

Radioimmunological methods using monoclonal antibodies can underevaluate FSH and LH levels under circumstances in which the distribution of isoforms may vary. Discrepancy must lead to the measure of gonadotrophins using polyclonal immunoenzymatic methods.

Understanding the influence of gender role identity on the assumption of family caregiving roles by men

Previous explanations of limited participation by males as family caregivers assume that socialization to dominant gender stereotypes is a universal barrier among men. Overlooked are 1) variations in the degree of internalization of gender typed attitudes that enable intense participation in a wide variety of personal care tasks and the assumption of the chief caregiver role among some men, and 2) social psychological processes used to resolve cognitive dissonance among men considering caregiver activities and/or role enactment. The present examination of these processes is responsive to calls for enhancing our understanding of the personal meaning that caregiving has for men. The introduction of Risman's view that current experience influences socialized predispositions, allows the delineation of conditions under which husbands, sons, and other male relatives who have internalized stereotypical self images of masculinity can also assume caregiver roles in the family. Drawing on interview data from a purposive sample of thirty-two men who were chief caregivers for elderly relatives, case study material is presented to illustrate several pathways by which male respondents gained access to family caregiving roles.

Imposed work and oxygen delivery during spontaneous breathing with adult disposable manual ventilators

BACKGROUND

Manual ventilators (resuscitators) are used primarily to ventilate the lungs of patients lacking spontaneous ventilatory effort. However, in many settings patients are allowed to breathe through the manual ventilator. Although many aspects of manual ventilator function have been studied, very little has been reported on the use of manual ventilators during spontaneous breathing. The purpose of this study was to evaluate inspiratory and expiratory imposed work of breathing and oxygen delivery during spontaneous breathing through disposable manual ventilators.

METHODS

Simulated spontaneous breathing was established with a two-chambered test lung, with one chamber serving as the test chamber and the other as the driving chamber. Imposed work of breathing was evaluated with decelerating inspiratory flow at a rate of 20 breaths/min at tidal volume (VT) 0.25 1 and peak flow 40 l/min, at VT 0.5 l and peak flow 80 l/min, and VT 0.81 and peak flow 120 l/min. Flow (integrated to volume) and pressure were measured between the manual ventilator and test lung, and inspiratory and expiratory imposed work of breathing were calculated by integration of the volume-pressure curve. Oxygen concentration was measured with an oxygen analyzer placed between the manual ventilator and the test lung at 20 breaths/min, VT 0.5 l, and flow 45 l/min. An oxygen flow of 15 l/min was added to the device for all evaluations. Two of the manual ventilators had built-in positive end-expiratory pressure valves, and imposed work was evaluated at 10 cmH2O with these.

RESULTS

There were significant differences in imposed work between inspiration and expiration (P < 0.001) and among the three levels of ventilatory demand (P < 0.001). For each ventilatory demand, there was a significant difference in work between manual ventilator brands for inspiratory work and expiratory work (P < 0.001). At a VT of 0.5 l and peak flow of 80 l/min, the pooled inspiratory imposed work for all manual ventilators was 0.44 +/- 0.12 J/l, and the pooled expiratory imposed work was 0.29 +/- 0.05 J/l. With 10 cmH2O positive end-expiratory pressure, the inspiratory imposed work was very high (> 1 J/l). Four of the devices were unable to deliver more than 0.85 oxygen concentration at the spontaneous ventilatory pattern evaluated.

CONCLUSIONS

Adult disposable manual ventilators produce a substantial imposed work of spontaneous breathing, which is increased with the addition of positive end-expiratory pressure. With some manual ventilators, a high oxygen concentration may not be delivered during spontaneous breathing. We recommend that patients not be allowed to spontaneously breathe through disposable manual ventilators.

Bioconversion of the sodium salt of Simvastatin (MK-733) to 6-desmethyl-6-α-hydroxymethyl Simvastatin

An actinomycete (MA 6474, ATCC 53828) isolated from a soil sample (Mutare, Zimbabwe) was found to biotransform the sodium salt of Simvastatin (MK-733) to 6-alpha-hydroxymethyl MK-733, 6-beta-hydroxymethyl MK-733, and 6-ring-hydroxy MK-733. The bioconversion efficiency to the desired compound, 6-alpha-hydroxymethyl MK-733, was enhanced by optimizing the physico-chemical parameters of the process. In shake flask cultures, addition of magnesium (0.125 mg/l Mg SO4.7H2O) to the medium resulted in a five-fold increase in the rate of bioconversion to the alpha diastereomer. The ratio of bioconversion products (6-alpha-hydroxymethyl,6-beta-hydroxymethyl, and 6-ring-hydroxy MK-733) was regulated by pH. Process improvements and scale up in 23-1 fermentors, which consisted of a controlled addition of substrate (MK-733), resulted in a 2-fold increase in alpha diastereomer production (42 vs. 79 U/ml) and a 23-fold rate increase in the formation of alpha-diastereomer. A high diastereomeric ratio (alpha: beta = 9:1) facilitated downstream processing.

[Psychiatric care in Leipzig--10 years' regionalized care in a large city by 3 major clinics]

The paper deals with experience gained in the town of Leipzig in the course of the implementation of the regionalized organisation of psychiatric care. The idea behind the organisational structure is that of a complete psychiatric system of treatment, covering hospitalised, partially hospitalised, and out-patient treatment, supported by ancillary services, to provide continued care. The organisational structure has proved effective for basic psychiatric care in a large town.

Borderline personality and victims of incest

This article explored the apparent relationship between the diagnosis of borderline personality disorder and the victims' experience of incest. While a review of the related literature is discussed to identify the apparent correlation, results of a preliminary study are consistent with the association. Recognizing the limitations inherent in the study, some tentative conclusions are offered.

Rhinomanometry--a review

After a short historical review, the advantages and disadvantages of the current rhinomanometric methods are discussed. In addition, the merits of spirometry or measurements of the air velocity are considered. The physics of nasal ventilation are described and the difficulty in nasal resistance measurement is studied. The different mathematical models representing nasal airflow are presented and the importance of the Broms' mathematical model is stressed.

Induction of ovulation with clomiphene citrate followed by LH-RH in women

Luteinizing hormone-releasing hormone (LH-RH) was used to induce ovulation following clomiphene priming to stimulate follicular growth. Ovulation was assumed to have occurred following LH-RH injection when progesterone levels started to rise within 48 h following treatment and LH pretreatment levels were below 8 mIU/ml. Ovulation occurred in eight of 10 patients following the administration of LH-RH and six pregnancies were achieved in the first 4 months of treatment.

Physiologic cardiac hypertrophy corrects contractile protein abnormalities associated with pathologic hypertrophy in rats

To evaluate the combined effects of cardiac overload imposed by hypertension and by chronic exercise, male and female rats were made hypertensive by unilateral renal artery stenoses and made to exercise in an 8-10-wk swimming program. Sedentary normotensive animals, sedentary hypertensive animals and normotensive animals exposed to the swimming program were also studied. Hypertension was associated with the development of cardiac hypertrophy, and this was exaggerated in hypertensive swimmers. Actomyosin, Ca2+-myosin, and actin-activated Mg2+-myosin ATPase activities were enhanced in normotensive swimmers, depressed in hypertensives and were normal or increased in hypertensive swimmers. Myosin isoenzyme analysis showed a predominant V1 pattern in normals; an increase in percent V1 isoenzyme is swimmers; a predominant V3 pattern in hypertensives; and a return to the predominant V1 pattern in hypertensive swimmers. These findings suggest that the hypertrophy imposed by hypertension and hypertrophy imposed by physical training using a chronic swimming program are distinctly different biological phenomena. Physical training by swimming prevents the changes in cardiac myosin induced by hypertension despite the exaggeration of hypertrophy.

The classic. Exposure of ruptured lumbar discs: a technical discussion

Technical problems in disc surgery are discussed. Hypotension keeps bleeding under control while surgery is in progress and offers a good view of the exposed area. Hypotension protects against postoperative haematoma. The approach must limit damage to important functional elements. By making the incision in the dorsal fascia lateral to the spinous processes and closing the wound with the spine flexed, postoperative tightness is less pronounced. Extensive disc removal protects against disc material being squeezed out when early weightbearing is permitted. The patient is allowed to leave bed the day after surgery. No physiotherapy, no support, no fusion are needed.

The participation of the black aged in voluntary associations

Racial differences in membership in and attendance of voluntary associations were analyzed for comparable samples of 753 black and 260 white residents of Philadelphia age 65 and over. A hypothesis suggesing aged blacks have higher rates of participation than aged whites was derived from the literature and tested by regression analysis. Potentially confounding variables, e.g., health and socioeconomic status, were entered into the regression equation as controls. The results of the regression analysis indicated the black aged belonged to more associations than the white aged and had higher rates of attendance. Examination of findings previously reported by Kent and Hirsch (1972) indicates part of the difference is due to the greater participation of aged blacks in church-related groups. Implications of the findings are briefly discussed.