Use of private offices in education of residents in internal medicine

Of the 440 accredited residency programs in internal medicine, 129 assign residents to private offices. From this group, 29 program directors with 47 resident-preceptor teams matched to the same offices submitted a complete set of questionnaires for analysis. The results provide information concerning the selection process for this assignment, its design and development, the nature of the educational activities, and evaluation and financing. The results suggest that the private office may be an effective learning experience for medical residents and an underused educational resource. A particular strength of the experience may be the frequent and effective resident-preceptor interactions, which seem to focus mostly on problem identification and clinical decision making.

Functional hyposplenism, a diagnostic clue in amyloidosis. Report of six cases

Six cases of functional hyposplenism associated with amyloidosis are presented. This association has been infrequently reported. Typical erythrocytic changes were found at initial presentation in five patients, and provided an early clue to the correct diagnosis. Extensive amyloid effacement of the splenic cords was the anatomic basis of the functional hyposplenism. Comments are made on the etiology and infective consequences of adult-acquired functional hyposplenism. A more sensitive method of screening peripheral blood for changes of functional hyposplenism is discussed.

Studies of the biosynthesis of renin with a cell-free translation system

1. Poly(A)+ mRNA from mouse submaxillary gland encodes a polypeptide of molecular weight 48 000 (48K polypeptide) which is abundant in the male. 2. This polypeptide is selectively absent in the translation products of mRNA from a strain of genetically renin-deficient mice C57 BL/10J. 3. The 48K polypeptide binds and co-elutes in identical fashion with pure authentic renin on pepstatin affinity chromatography. 4. Immunoprecipitation of translation products of male glandular mRNA with renin-specific antibody yielded this 48K band upon analysis by SDS/polyacrylamide gel electrophoresis and fluorography. Pure renin of molecular weight 37 000 blocked the binding of this polypeptide to antirenin antibody. 5. Mouse submaxillary gland synthesizes a renin precursor. The renin mRNA is androgenically regulated.

HLA restricted virus-specific cytotoxic T-lymphocyte responses to live and inactivated influenza vaccines

36 young adult volunteers were given either virus, or inactivated surface-antigen influenza vaccine, containing influenza A (H1N1) antigen. Their peripheral-blood lymphocytes were analysed to determine whether cytotoxic T lymphocytes (CTL) were induced by these vaccines. All three vaccines induced HLA-restricted T-lymphocyte responses specific for influenza A virus. This CTL response was found in 28 of 30 volunteers who showed antibody responses and in 3 of 6 who did not develop antibodies. Virus infected target cells showing certain HLA antigens (A1, A9, and B8) were less susceptible to lysis by HLA-matched cytotoxic T effector cells than target cells which matched effectors at other HLA loci.

The second public health revolution: a critical appraisal

This paper presents a critical reaction to the Surgeon General's recent report and recommendations on American health. Entitled Healthy People, the report has been described as providing impetus for a "second public health revolution." Our analysis leaves us less than enthusiastic. We first summarize the Report, noting its heavy emphasis on lifestyle. We then compare its tenets with those of the nineteenth century public health revolution. The Report recognizes social and economic conditions as significant factors in determining health but fails to incorporate this recognition in its policy recommendations. Instead, it places the burden of its recommendations on the reform of individual behavior. We explain this focus in terms of the continued centrality of the ideology of individualism and its collective counterpart, social and political pluralism. We then examine the ways in which these ideologies act on the Report and we suggest why the proposals they shape are unlikely to be successful.

Role of the periaqueductal grey in vocal expression of emotion

In 32 squirrel monkeys (Saimiri sciureus) the role of the periaqueductal grey has been investigated by combined stimulation/lesioning and by neuroanatomical experiments. The results are as follows. Firstly, periaqueductal lesions invading the laterally adjacent tegmentum abolish species-specific calls elicitable by electrical brain stimulation. This holds for stimulation sites rostral as well as caudal to this area. The only vocalizations which survive are phonations of an artificial character which can be evoked from the lateral medulla. Spontaneous vocalizations also seem to be abolished. Secondly, vocalizations elicited from the periaqueductal grey are not affected by bilateral lesions in vocalization-eliciting areas rostral to it, but are abolished by lesions in the dorsolateral pons and ventrolateral medulla. Thirdly, the periaqueductal grey receives direct projections from all vocalization-eliciting areas tested, viz. the precallosal cingulate gyrus, gyrus rectus, medial amygdata, central amygdaloid nucleus/substantia innominata, nucleus striae terminalis, dorsal hypothalamus, midline thalamus, periventricular grey, dorsolateral and ventrolateral midbrain tegmentum. Fourthly, the periaqueductal grey projects directly to the nucleus ambiguus, the site of the laryngeal motoneurones. The course of the main bulk of fibres corresponds to the lesion sites effective in abolishing periaqueductally elicited vocalizations. From these results, it was concluded that the caudal periaqueductal-lateral tegmental area is a necessary relay station for all external and internal stimuli capable of inducing species-specific calls. Its position within the stimulus-response loop seems to be on the output side, immediately above the level of motor-corrdination but below that of stimulus recognition.

The cingular vocalization pathway in the squirrel monkey

In 39 squirrel monkeys (Saimiri sciureus), the effects of various brain lesions on vocalizations elicited from the precallosal cingulate gyrus were tested. It was found that lesions abolishing the "cingular vocalization" completely can be traced from the stimulation site continuously down to the laryngeal motoneurons in the nucleus ambiguus. The pathway thus determined (Fig. 4) travels from the precallosal cingulate gyrus through the frontal white matter and enters the internal capsule from a dorsolateral position. The pathway then follows this structure in a medio-caudal direction down to the caudal diencephalon. Here, the effective lesions leave the corticospinal tract and ascend dorsally into the periaqueductal grey. The pathway follows this structure to its end where it sweeps lateral through the parabrachial area and then descends through the lateral pons and ventrolateral medulla to the nucleus ambiguus. In nine of the animals, in addition, the effects of bilateral anterior cingular lesions on vocalizations elicited in other brain areas were tested. It was found that the only vocalization-eliciting area which becomes ineffective after destruction of the anterior cingulate gyrus is the postero-medial orbital cortex.

Childhood antecedents of adult obesity. Do chubby infants become obese adults?

We investigated whether obese infants tend to become obese adults. Records of subjects born between 1945 and 1955 were reviewed to select three cohorts based on weight in the first six months of age, which exceeded the 90th percentile at least once, ranged between 25th and 75th percentiles or was below 10th percentile at least once. Three hundred and sixty-six subjects, now between 20 and 30 years of age, were located and their present height and weight determined. Thirty-six per cent of those exceeding the 90th percentile as infants were overweight adults, as compared to 14 per cent of the average age and light-weight infants. A significant increase (chi square = 17.2, p less than 0.001) in adult obesity was evident when the infant exceeded the 75th percentile that was independent of his height. Social class, educational level, and parental weight all correlated with adult weight (p less than 0.001). Sex and ordinal position of birth did not. The data suggest that infant weight correlates strongly with adult weight independently of other factors considered.