The sensation of facial swelling in temporal arteritis: a predictor for the development of visual disturbance

The sensation of facial swelling in temporal arteritis may be an important predictor of the development of visual disturbance. A clinical report of two patients who developed a sensation of puffiness of the face without altered facial appearance, as a presenting symptom of temporal arteritis with visual disturbance is presented. This symptom, though documented previously by us, has not been identified before as a predictor of visual disturbance.

Rupture of extensor digitorum communis after distal ulnar styloidectomy

Attrition ruptures of tendons in the hand, other than those caused by rheumatoid arthritis, are rare. We report a case in which high styloidectomy of the distal ulna caused the rupture of the extensor digitorum communis tendon to the long finger. This complication can be avoided by resection of the smallest segment of the distal ulna that is compatible with relief of the problem. Soft tissue closure over the resected end of the ulna should also be carried out.

Calcinosis cutis--a rare late complication of burns

Pillars of calcification are rarely found in the skin. An interesting case is described where rows of new bone developed in the skin which had been grafted 31 years previously to cover partial skin thickness burns of the shin. The problems of heterotropic ossification are discussed.

Septic arthritis of the sternoclavicular joint

An adult patient with isolated septic arthritis of the sternoclavicular joint (SCJ) caused by Staphylococcus aureus is described. The patient had no underlying diseases other than paronychia, which might have served as the portal of entry. Antibiotic therapy resulted in clinical cure but x-ray revealed progression of the destructive process.

Medicare beneficiary decision making about health insurance. Implications for a voucher system

A two-phase study involving focus group interviews and a survey of 2,016 Medicare beneficiaries was conducted to examine beneficiary decision making about health insurance under a hypothetical Medicare voucher program. Some of the major findings were that: beneficiaries lack important information about Medicare and health insurance in general; plans with physician restrictions, no restrictions on hospitals, and benefits for custodial long-term care at home or in nursing homes are most preferred when prices are roughly equal to actuarial costs; plan features often interact rather than combined additively to affect choices; price sensitivity is small in comparison with sensitivity to other plan features; price sensitivity is particularly small for plans with custodial long-term care benefits; Medicare would not experience substantial selection bias in a voluntary system containing a wide range of plans preferred by beneficiaries; physician-restricted plans would experience favorable selection; plans with long-term custodial care benefits would experience some adverse selection which might be handled by modest price adjustments in view of the relatively low price elasticity of preferences.

Age-dependent cell death in the olfactory cortex: lack of transneuronal degeneration in neonates

Adult olfactory cortical neurons in layer IIa undergo fulminant transneuronal degeneration after removal of afferent olfactory bulb fibers (Price, '76, Neurosci Abst. 2:161; Heimer and Kalil, '78, J. Comp. Neurol. 178:559-609). This provides an unusual example of dependence of a mature population of neurons on axonal input. In order to investigate whether similar transneuronal degeneration occurs in immature animals, a series of rats were subjected to unilateral olfactory bulb removal at various ages during the first 3 postnatal weeks. The brains were examined for degeneration after short survivals by use of the de Olmos cupric silver method, which selectively stains degenerating neurons. In addition, animals with long survivals were examined with the HRP retrograde tracing method, in order to determine if cells that survive the acute effects of deafferentation develop normal patterns of connections. Young neurons are more resistant to the effects of olfactory bulb removal than more mature neurons. There was little degeneration of cortical neurons after bulb ablation during the first 2 postnatal weeks. Although layer IIa does not become distinct from layer IIb in these experimental animals, cells that have connections normally characteristic of the cells of layer IIa, and are situated at the superficial edge of layer II, were identified with the HRP method. The severity of transneuronal degeneration increases and becomes adultlike between the second and third postnatal weeks. This increase in transneuronal degeneration is temporally associated with a progressive reduction in axonal sprouting following deafferentation during the first 3 postnatal weeks, as described in the companion paper (Friedman and Price, '86). Thus, axon sprouting may "protect" the immature IIa neurons from the effects of removal of the fibers from the olfactory bulb. A period of normal cell death has also been identified in olfactory cortex by the use of the de Olmos cupric silver method. This cellular degeneration is much less severe and has a different time course and laminar distribution than the transneuronal degeneration produced by olfactory bulb ablation in adults. Although normal cell death appears to be potentiated by removal of the olfactory bulb on postnatal day 1, it is clearly a different process from the transneuronal reaction.

Age-dependent cell death in the olfactory cortex: lack of transneuronal degeneration in neonates

Adult olfactory cortical neurons in layer IIa undergo fulminant transneuronal degeneration after removal of afferent olfactory bulb fibers (Price, '76, Neurosci Abst. 2:161; Heimer and Kalil, '78, J. Comp. Neurol. 178:559-609). This provides an unusual example of dependence of a mature population of neurons on axonal input. In order to investigate whether similar transneuronal degeneration occurs in immature animals, a series of rats were subjected to unilateral olfactory bulb removal at various ages during the first 3 postnatal weeks. The brains were examined for degeneration after short survivals by use of the de Olmos cupric silver method, which selectively stains degenerating neurons. In addition, animals with long survivals were examined with the HRP retrograde tracing method, in order to determine if cells that survive the acute effects of deafferentation develop normal patterns of connections. Young neurons are more resistant to the effects of olfactory bulb removal than more mature neurons. There was little degeneration of cortical neurons after bulb ablation during the first 2 postnatal weeks. Although layer IIa does not become distinct from layer IIb in these experimental animals, cells that have connections normally characteristic of the cells of layer IIa, and are situated at the superficial edge of layer II, were identified with the HRP method. The severity of transneuronal degeneration increases and becomes adultlike between the second and third postnatal weeks. This increase in transneuronal degeneration is temporally associated with a progressive reduction in axonal sprouting following deafferentation during the first 3 postnatal weeks, as described in the companion paper (Friedman and Price, '86). Thus, axon sprouting may "protect" the immature IIa neurons from the effects of removal of the fibers from the olfactory bulb. A period of normal cell death has also been identified in olfactory cortex by the use of the de Olmos cupric silver method. This cellular degeneration is much less severe and has a different time course and laminar distribution than the transneuronal degeneration produced by olfactory bulb ablation in adults. Although normal cell death appears to be potentiated by removal of the olfactory bulb on postnatal day 1, it is clearly a different process from the transneuronal reaction.

Plasticity in the olfactory cortex: age-dependent effects of deafferentation

In order to assess the role of input-target interactions in the development of olfactory cortex, the primary afferent fibers from the olfactory bulb to the superficial part of layer I of the cortex (layer Ia) were removed in developing and mature rats. After survival periods that vary from a few days to 2-6 months, changes were assessed in (1) the radial thickness of layer I, (2) the laminar distribution of intracortical associational fibers, which normally terminate in a deep part of layer I (layer Ib), and (3) the distribution of glia in layer I. The findings indicate that the lamination of fibers within layer I is not intrinsically prespecified, but gradually becomes "set" during the first month after birth. If the fibers from the olfactory bulb are removed, the dendrites of cortical cells are capable of accepting inputs from other fiber systems, depending on the maturational state of the dendrites and the ingrowing axons. Development of the abnormal inputs is associated with relatively normal dendritic growth, whereas lack of adequate input results in dendritic atrophy. Thus, after neonatal bulb ablation, the intracortical fibers occupy both superficial and deep parts of layer I, and a normal synaptic density is established throughout the layer. Layer I also develops to nearly its normal adult thickness, although the high density of glia that normally characterizes layer Ia is not apparent. With bulb ablation at progressively older ages (from postnatal day (P-) 3 to 21), the cortical associational fibers show progressively less extension into the denervated layer Ia. Layer I continues to grow, but not to the same extent as after P-1 ablations. In these experiments the glia distribution resembles the pattern present at the time of denervation. After adult olfactory bulb ablation, the long intracortical fibers extend very little into layer Ia, which undergoes pronounced shrinkage and becomes filled with a high concentration of glia. However, partial reinnervation of layer Ia is accomplished by the proliferation of a normally sparse native fiber system, which has been identified only with the Timm method. These results are interpreted as evidence that the normal development of lamination of afferent fibers to the olfactory cortex depends on axodendritic interaction during development.

Atropine and glycopyrrolate as ECT preanesthesia

Twenty-four patients receiving ECT were systematically studied to compare the effects of two dosages of atropine and two dosages of glycopyrrolate as preanesthetic agents. Glycopyrrolate resulted in more cardiac arrhythmias, nausea and vomiting, and episodes of bradycardia than atropine (p = .4). More patients receiving atropine showed post-ECT confusion, but the clinical impact of this was minimal. Atropine appears to be preferable to glycopyrrolate for use in ECT preanesthesia.

The diagnostic value of computed tomography in a selected case of penetrating thoraco-abdominal injury

A patient with a penetrating thoraco-abdominal injury produced by a pencil left in situ is described. CT scan accurately demonstrated the innocuous path of the pencil which was removed without sequelae. CT scan may be valuable in the management of penetrating injuries of the trunk with weapon still in place.

Evaluation of the pharmacodynamic and pharmacokinetic interaction between calcium antagonists and digoxin

Therapeutic uses of calcium antagonists have expanded to include not only ischemic heart disease but arrhythmias, systemic hypertension, congestive heart failure, and various pulmonary and gastrointestinal diseases. Many patients receiving a calcium antagonist concomitantly receive digoxin. Although the potential interaction between these agents has frequently been investigated, literature reports are confusing and inconsistent. We summarized the pharmacodynamics, pharmacokinetics, and mechanisms of interaction to help clinicians evaluate the potential calcium antagonist-digoxin interaction.

Injured neurons in the olfactory bulb of the adult rat grow axons along grafts of peripheral nerve

Certain neurons in the central nervous system (CNS) of adult mammals extend axons for several cm along peripheral nerve grafts inserted into the brain or spinal cord. It is not clear, however, if these nerve cells constitute a special population or are examples of a general capacity of the injured mammalian CNS to regrow processes under these experimental conditions. Furthermore, because the new axons could originate by collateral sprouting from uninjured neurons, it is important to prove that the interruption of a central axonal projection can be followed by extensive fiber regrowth from the damaged neurons. In this anatomical study, we examined whether: (1) nerve cell type; and (2) axotomy, influence CNS axon regrowth along peripheral nerve grafts. For this purpose, we grafted segments of sciatic nerve into the olfactory bulb (OB) of adult rats and used combinations of neuroanatomical tracers (horseradish peroxidase and the fluorescent dyes True Blue and Nuclear Yellow) to investigate axonal regrowth from the different neurons that normally populate the OB. We demonstrate that OB axons extending along peripheral nerve grafts originate from mitral and tufted cells near the graft tip, rather than from the smaller OB neurons (periglomerular, short axon, and granule cells). Most of the mitral and tufted cells that extend new axons in grafted peripheral nerve segments lose their normal projections through the lateral olfactory tract because of axotomy at the time of grafting. Neuronal type, damage, and proximity to the graft appear to be prerequisites of this regenerative response from the OB.

Thallium-201 scintigraphic visualization at rest of a dilated and hypertrophied right ventricle in a patient with sarcoidosis complicated by cor pulmonale

Visualization, by resting TI-201 scintigraphy, of a markedly enlarged right ventricle (RV) in a 48-year-old black man with a 20-year history of pulmonary sarcoidosis is presented. The RV was three to four times larger than the left ventricle. Sarcoidosis resulted in marked distortion of the thoracic contents, as shown by the radiograph. This distortion possibly accounts for optimal scintigraphic visualization of the enlarged RV in the left lateral projection rather than in the left anterior projection. Because of the distortion, the chest radiograph could not be used to evaluate the cardiac contour; TI-201 scintigraphy demonstrated the RV enlargement.

Hospital expenses in a sector model

This review summarizes the capabilities and contributions of quantitative sector models for understanding trends in hospital expenses and the effects thereon of various public policies. After some brief historical notes on the use of analogous models in other policy areas, the general classes of national, partial, and narrow health sector models are introduced with special attention to method of validation and behavioral structure. Fourteen published models, described and critically reviewed with regard to these criteria, are assessed for their individual application to important policy and behavioral issues. Suggestions are offered for improvements and new initiatives in the use of sector models both in forecasting and in the study of procompetitive policies and reimbursement rule changes.

Effect of naloxone on ventilatory control in parents of victims of sudden infant death syndrome

To determine whether the decreased responses to CO2, hypoxia, and flow resistive loads in parents of sudden infant death syndrome (SIDS) victims are due to an effect of endogenous opioids, we tested response to these stimuli in 10 parents (5 couples) of such children after injection of saline placebo and after injection of naloxone hydrochloride (3 mg). The responses after saline were comparable to those of our previous study, i.e., lower than normal. Ventilatory response to CO2 and hypoxia, as well as airway occlusion pressure responses to flow resistive loading, were not significantly different after naloxone compared with saline. We concluded that increased endogenous opioids do not play a significant role in these subjects' reduced ventilatory drive.

Diacylglycerol modulates binding and phosphorylation of the epidermal growth factor receptor

Tumor promoters cause a variety of effects in cultured cells, at least some of which are thought to result from activation of the Ca2+-phospholipid-stimulated protein kinase C. One action of tumor promoters is the modulation of the binding and phosphorylation of the epidermal growth factor (EGF) receptor in A431 cells. To determine if these compounds act on the EGF receptor by substituting for the endogenous activator of C kinase, diacylglycerol, we compared the effects of the potent tumor promoter 12-O-tetradecanoyl phorbol 13-acetate (TPA) with those of the synthetic diacylglycerol analog 1-oleyl 2-acetyl diglycerol (OADG). When A431 cells were treated with TPA, the subcellular distribution of C kinase activity shifted from a predominantly cytosolic location to a membrane-associated state; OADG also caused the disappearance of cytosolic C kinase activity. The shift in the subcellular distribution of C kinase, caused by TPA or OADG, correlated with changes in binding and phosphorylation of the EGF receptor. OADG, like TPA, caused loss of binding to an apparent high affinity class of receptors, blocked EGF-induced tyrosine phosphorylation of the EGF receptor, and stimulated phosphorylation of the EGF receptor at both serine and threonine residues. No difference between the phosphopeptide maps of receptors from cells treated with OADG or TPA was observed. Thus, it appears that tumor promoters can exert their effects on the EGF receptors by substituting for diacylglycerol, presumably by activating protein kinase C. Further, these results suggest that endogenously produced diacylglycerol may have a role in normal growth regulatory pathways.

Tumor promoters block tyrosine-specific phosphorylation of the epidermal growth factor receptor

Tyrosine-specific phosphorylation of the epidermal growth factor (EGF) receptor in hormonally stimulated A431 cells is blocked by three chemically distinct classes of tumor promoters. Tumor-promoting esters of the diterpene phorbol (phorbol 12-myristate 13-acetate, beta-phorbol 12,13-dibutyrate, and beta-phorbol 12,13-didecanoate), indole alkaloids (teleocidin and lyngbyatoxin A), and polyacetates ( aplysiatoxin and debromoaplysiatoxin ) all inhibited EGF-stimulated phosphorylation of the receptor. Non-tumor-promoting analogs (beta-phorbol, alpha-phorbol 12,13-didecanoate, and hydrolyzed teleocidin) had no effect on the levels of receptor phosphorylation. The ED50 values of the inhibitory effect (0.1-3 ng/ml) reflected the relative tumor-promoting abilities of these compounds in vivo. None of the tumor promoters tested significantly decreased the overall specific binding of 125I-labeled EGF to A431 cells. Scatchard analysis, however, revealed two apparent EGF receptors in this cell type. The dose-responses for tumor-promoter inhibition of EGF receptor tyrosine phosphorylation and high-affinity EGF binding were similar, suggesting that the same initial event is responsible for both effects. This demonstrates a correlation between modulation of EGF receptor binding and phosphorylation of tyrosine by tumor promoters. The data suggest a possible role for protein kinase C, the putative cellular receptor for these tumor promoters, in the mechanism of action.

Fiber systems in the olfactory bulb and cortex: a study in adult and developing rats, using the timm method with the light and electron microscope

The structure of the olfactory bulb and cortex of rats is described using the Timm method, in which endogenous transition or "heavy" metals are precipitated with sulfide and then stained with silver. With the light microscope, two types of staining, a fine, "colored" reaction and a coarse, "granular" reaction, are found in the neuropil of the adult forebrain; neuronal somata, fiber tracts, and some specific areas of the neuropil are almost unstained. With the electron microscope the Timm method consists of small silver granules, which are associated with axon terminals. These granules are located over the external surface of the presynaptic membrane, facing the synaptic cleft, and over synaptic vesicles, especially the internal surface of the vesicle membrane. This localization suggests that the reactive metals are related to a membrane component which is recycled during secretion of synaptic transmitters. The colored and granular reactions seen with the light microscope appear to be correlated with different intensities of staining of different types of axon terminals. The full extent of the olfactory cortex can be delineated by a bilaminar staining pattern in layer I, which coincides with the pattern of termination of fiber systems to the cortex demonstrated by axonal tracing experiments. The superficial part of layer I is very palely stained; this corresponds precisely to layer Ia, the zone of termination of fibers from the olfactory bulb. In contrast, the deep part of the layer is stained with an intense colored reaction; this corresponds precisely to layer Ib, the zone of termination of the major association fiber system within the olfactory cortex. A prominent granular reaction, which does not correspond to any known long axon system, is found in all layers of the cortex, although it is concentrated at the superficial edge of layer Ib and in layer II. Variations in staining in the several subdivisions of the olfactory cortex are illustrated and described. In the olfactory bulb, the most prominent staining is a relatively fine, granular reaction in the glomerular formations, which apparently corresponds to the olfactory nerve terminals. In immature rats, the Timm method stains the neuropil throughout the olfactory system, although the patterns and quality of staining differ from that found in adults. Before birth, the best-differentiated reaction is seen in glomeruli of the olfactory bulb and correlates well with the pattern of olfactory nerve ingrowth.(ABSTRACT TRUNCATED AT 400 WORDS)

United States experience with oxprenolol in hypertension

Double-blind, randomized, parallel-group studies have confirmed that oxprenolol, either alone or in combination with a thiazide, is effective in reducing elevated blood pressure. In 2 of 3 comparisons with placebo, the blood pressure reduction was significantly more effective with oxprenolol; in 1 study, even though the placebo response was pronounced, oxprenolol was still more effective than placebo. In 2 studies propranolol reduced blood pressure by about 2 mm Hg more than oxprenolol. In the larger, longer-term study this difference was significant at the end of the dose-titration period, but there were no significant differences between the 2 treatment groups at study end. Moreover, oxprenolol reduced heart rate less and was associated with fewer side effects. Oxprenolol effectively lowered blood pressure when given once daily and was well tolerated, even in large doses. Blood pressure was reduced less with oxprenolol than with hydrochlorothiazide, -14/-11 versus -20/-13 mm Hg. The mean reduction with oxprenolol was less for black patients than for white. In a 1-year safety study, 86% of the patients continued to have a diastolic pressure of less than 90 mm Hg at study end.

A double-blind study of oxprenolol once and twice daily in hypertensive patients

In a randomized double-blind study of 175 patients with mild-to-moderate hypertension, oxprenolol hydrochloride (160-480 mg) given once daily was compared with the same drug given twice daily for efficacy, safety, and tolerability. Of these patients, 123 (58 receiving the once daily regimen and 65 receiving the twice daily regimen) were included in the analysis of efficacy. Both groups showed similar significant (p less than 0.01) reductions in mean blood pressure during the 6-week titration period and for the remainder of the trial. A comparison of mean standing diastolic blood pressure and supine systolic and diastolic blood presses showed no significant difference between groups during the fixed dosage period. The number of patients reporting adverse experiences was not significantly different for the two regimens. Plasma triglycerides increased in both groups, but there were no other laboratory abnormalities related to treatment. This study shows that oxprenolol given once daily is effective, safe, and well tolerated in the treatment of mild-to-moderate hypertension.

A new approach to hospital cost functions and some issues in revenue regulation

An important aspect of hospital revenue regulation at the State level is the use of retroactive allowances for changes in the volume of service. Arguments favoring non-proportional allowances have been based on statistical studies of marginal cost, together with concerns about fairness toward non-profit enterprises or concerns about various inflationary biases in hospital management. This article attempts to review and clarify the regulatory issues and choices, with the aid of new econometric work that explicitly allows for the effects of transitory as well as expected demand changes on hospital expense. The present analysis is also novel in treating length of stay as an endogenous variable in cost functions. We analyzed cost variation for a panel of over 800 hospitals that reported monthly to Hospital Administrative Services between 1973 and 1978. The central results are that marginal cost of unexpected admissions is about half of average cost, while marginal cost of forecasted admissions is about equal to average cost. We obtained relatively low estimates of the cost of an "empty bed." The study tends to support proportional volume allowances in revenue regulation programs, with perhaps a residual role for selective case review.

Economic incentives in nosocomial infection control

To a new student in this field, with a background in the economics of health care financing and insurance, there appear to be many challenging issues regarding: a) the efficacy of particular infection control measures; b) the calculation of economic benefit from particular measures; c) the determinants of the actual levels of expenditure on infection control and the measures actually adopted; and d) the rationale and pitfalls of regulatory standards such as those recommended by the Centers for Disease Control or adopted by the Joint Commission on Accreditation of Hospitals.

A program for parents of children with sensory integrative dysfunction

The pilot parent program described in this article is based on literature that suggested greater parental acceptance of a child would help the child make gains in self-esteem. Six parents of children with sensory integrative dysfunction were seen individually for 6 weeks in order to enhance the parents' understanding of their children's sensory integrative problems and to discuss ways to help build their child's self-esteem. Using the Porter Parental Acceptance Scale as a pre- and post-program measure, the results were not significant; however, the parents' subjective evaluations indicated that the program helped them to increase their understanding of their children's problems and improved their ability to relate constructively to their children.

Epidemiology of temporal arteritis in Israel

An effort was made to identify all cases of biopsy-proven temporal arteritis (TA) diagnosed in Israel during 1960-78. A total of 46 Jewish patients was found, none of them under 50 yr of age. The age-standardized annual incidence rate of biopsy-proven TA among Jews in Israel rose from 1.6 in 1960-64 to 8.6 in 1975-78, with an overall incidence of 4.9 new cases diagnosed annually/10(6) population greater than or equal to 50 yr. The male:female ratio was 0.95. The annual incidence was 0.2 cases/10(6) population aged 50 to 59 yr, and 11.6/10(6) population greater than or equal to 70 yr of age. We feel that apparent increase in the incidence of TA is due to increased awareness of the disease rather than to an increase in morbidity.

Economic aspects of the rationing of nursing home beds

State governments, with federal subsidies under the Medicaid program, are the source of the largest share of expenditures to support patients in the long-term institutional nursing care. A major state policy tool that has been evolving is the authority to approve or deny expansions in bed capacity. This paper is an analysis of how the behavior of physicians and nursing homes operates, given present reimbursement policies, could determine the allocation of beds among patients. Both general evidence of inefficient allocation and the detailed experience in the State of Rhode Island before and after a period of rapid expansion of bed capacity lend support to the conceptual model of home-operator behavior. Some alternative structural reforms in Medicaid and in the rationing of beds are suggested in the final section.

Establishment of normal synaptic density in deafferented olfactory cortex

The piriform cortex has been examined in rats following neonatal deafferentation produced by olfactory bulb removal. The denervated molecular layer of the piriform cortex grows to nearly its full adult thickness and the removal olfactory bulb axons are replaced by intracortical axons. The synaptic density of the molecular layer following this rearrangement is the same as that in the normal cortex.

Field evaluation of the membrane filter-disc immunoimmobilization technique in the detection of salmonellae in egg products

The membrane filter-disc immunoimmobilization (MFDI) technique was found to more sensitive than the official US Department of Agriculture (USDA) method for the detection of salmonellae in unpasteurized egg whites, unpasteurized whole eggs, pasteurized dried eggs and pasteurized whole egg samples examined at two processing facilities over a period of 18 months. Of 70 samples of unpasteurized egg samples examined, 39 were positive for Salmonella by the official USDA method while 54 were positive by the MFDI method. All positive samples by the MFDI technique were confirmed by subculturing on differential plating media and by performing biochemical and serological tests on the isolates. Of 67 pasteurized liquid whole egg and dried egg white samples examined, all were negative for Salmonella by the USDA method while Salmonella was isolated by the MFDI technique from one sample of pasteurized whole egg product.

Labeling of preformed liposomes with Ga-67 and Tc-99m by chelation

We have synthesized a long-chain hydrocarbon covalently coupled to diethylene-triaminepenta-acetic acid (stearylamine-DTPA) and have incorporated this compound in liposomes during their preparation. The lipophilic hydrocarbon chain anchors the molecule in the lipid bilayer, exposing the DTPA groups on the surface for chelation. Ethanolic solutions of the lipids are evaporated to dryness under nitrogen in multidose vials; the lipids are suspended in the vial by adding a small volume of distilled water followed by sonication. The liposomes are then labeled by transcomplexation in the case of Ga-67 and by conventional stannous reduction in the case of Tc-99m, by adding the activities directly to the vial. These liposomes bind 95 +/- 5% of Ga-67 and Tc-99m activity, as determined by paper chromatograph assay, eliminating the need for a purification step. The labeled liposomes release about 5% of their Ga-67 activity, and about 30% of their Tc-99m activity after 2 hr of incubation in 50% human plasma at 37 degrees C. Activity released from liposomes labeled with Ga-67 or Tc-99m oxine is much greater under the same conditions. In normal mice the labeled liposomes show biodistributions that are comparable with that obtained with liposomes labeled by conventional techniques.

The incidence of spondylolysis and spondylolisthesis in nonambulatory patients

Radiographs were obtained of the lumbosacral spines of 143 patients that had never walked. The frequency of spondylolysis and spondylolisthesis was determined, as well as that of other spinal abnormalities. The average age of the patients was 27 years, with a range of 11 to 93 years. The underlying diagnoses responsible for the nonambulatory status varied, but cerebral palsy predominated. No case of spondylolysis or spondylolisthesis was detected, and when compared to the 5.8% incidence in the general population, this finding is significant at the P less than 0.001 level. The incidences of spinal bifida (8.4%) and of transitional vertebrae (10.9%) are similar to those found in the general population. Scoliosis was found in 49% and vertebral body height was increased in 32.9%. Degenerative changes occurred in only 2.8%. These results support the theory that spondylolysis and isthmic spondylolisthesis represent a fatigue fracture resulting from activities associated with ambulation.

Terminal transferase in acute lymphoblastic leukemia in gibbons

Terminal deoxynucleotidyl transferase, an enzyme which catalyzes the polymerization of deoxyribonucleoside triphosphates on a 3'-OH end of an initiator molecule in the absence of a template, has been suggested as a biological marker for human acute lymphoblastic leukemia. Examination of a cell line, 6G1, recently established from the peripheral blood of a gibbon ape with acute lymphoblastic leukemia showed the presence of terminal deoxynucleotidyl transferase. This enzyme after purification by successive column chromatography on DEAE-cellulose, phosphocellulose and hydroxyapatite, was found to have biochemical properties similar to those reported for terminal transferase from calf thymus and human leukemic cells. These studies suggest that terminal transferase can be used as a useful biological marker for acute lymphoblastic leukemia in both humans and subhuman primates.

Characterization of an RNA-directed DNA-polymerase from a cell line derived from a radiation-induced lymphoma in mice

An RNA-directed DNA polymerase was purified from a cell line derived from a radiation-induced lymphoma in NIH Swiss mice which produced non-infectious type C virus particles. The enzyme was isolated from a high speed particulate fraction which bands at a density of 1.16--1.19 g/ml in a sucrose gradient, and purified by successive chromatography on DEAE-cellulose, phosphocellulose and hydroxyapatite. The purified DNA polymerase has a molecular weight of 68 000, a pH optimum of 7.5, a KCl optimum of 50 mM, and a Mn2+ optimum of 0.25 mM. It prefers (dT)15 . (A)n to (dT)15 . (dA)n as the primer template and transcribes the poly(C) strand of (dG)15 .(C)n and (dG)15 . (OMeC)n. It transcribes heteropolymeric regions of avian myeloblastosis virus 70 S RNA, and is inhibited by antiserum to Rauscher murine leukemia virus DNA polymerase. Comparison of the properties of DNA polymerase purified from radiation-induced lymphoma cells with the DNA polymerase purified from non-defective murine type C RNA tumor viruses shows that the mouse lymphoma enzyme is both biochemically and immunologically related to murine leukemia virus DNA polymerases.

Family bequests and the derived demand for health inputs

A family investment model whereby parents allocate resources among their own consumption, health investments and financial bequests to children is specified and used to develop hypotheses which are tested on cross section data. As predicted by the model, the demand for physician visits for young children is found to 1) depend on family income only up to some level ($10,000 in 1969 $ in this case), 2) increase with maternal education, and 3) vary with price measures and family size, There is also evidence that greater health investments in young children pay off in fewer severe illnesses in young adulthood.

Temporal arteritis in Israel. A review of 47 patients

We reviewed the charts of 47 patients with biopsy proven temporal arteritis, hospitalized in 9 major hospitals in Israel. The age of onset and clinical manifestations of this disease in Israel are similar to those reported from other parts of the world. The disease is more frequent (greater than x 3) in Ashkenazi than in Sephardic Jews and only 1 patient was Arab. More than half of the patients (20/32) had laboratory evidence of liver damage reversible with treatment. Follow-up of 19 of these patients revealed that the treatment with corticosteroids was continued in most patients for more than 2 years.

Sharing arrangements in the nonprofit hospital industry

The major task of this paper is to develop hypotheses about voluntary sharing arrangements (SAs) from a plausible economic analysis of the hospital industry. The second task of the paper is to review some emerging evidence about SAs. Our research suggests that some SAs could or actually do reduce hospital costs to the community. However, there are reasons which indicate that cost reduction is neither a necessary nor a sufficient result for the success of many SAs.