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This paper examines the relationship between the intrathoracic and bronchial pressures and the flow time course during forceful expiration in patients with severe chronic airways obstruction and tracheobronchial collapse. After an initial peak flow, the flow rate (V) of forceful expirations usually fitted the patient's maximum expiratory flow volume (MEFV) curve. The great reduction in flow after the peak corresponded to a large reduction of the thoracic gas volume (TGV) due to the high intrathoracic pressures compressing the lungs. An occasional slight rise in flow in the middle of the slow phase corresponded to an increase of the TGV due to reduction of the intrathoracic pressure. The early peak flow was found to exceed considerably the ˙V expected from the MEFV curve. Pressure measurements in the right lower lobe bronchus suggest that this could be due to at least two factors: first, a rapid reduction in bronchial volume and, secondly, a short time lag before flow limitation develops, allowing initial rapid transit of air. During a forced expiration, flow limitation was initiated when the equal pressure points were sufficiently upstream to allow compression of small as well as large airways. The evidence suggested that tracheobronchial collapse followed the initiation of flow limitation and was unlikely to have had more than a slight subsidiary effect on the maximum flow. Due to greater compression, the TGV and hence the flow rate were smaller during a forceful expiration than during a less forceful expiration. [ABSTRACT FROM PUBLISHER]

This paper explores the extent and durability of satisfaction expressed by a group of chronicallyill aged patients and attempts to relate variations to some social, economic and health aspects of life as well as subjective perceptions of these conditions. Optimism is more widespread and durable than expected and seems to be related more to the perception of a given situation than the actual condition. [ABSTRACT FROM AUTHOR]

This article discusses the personality of the adult obese woman. The general purpose of the overall project is the formulation of personality indices which would distinguish overweight women from ideal weight women. Obesity was defined as an excess of weight over the ideal expected for height, sex, and build between the ages of 25 and 30. Ten per cent above and below the average was allowed. Desirable weights were obtained from tables issued by the Metropolitan Life Insurance Company. The subjects were volunteers in a Boston experiment sponsored by the Chronic Disease Division of the United States Public Health Service in cooperation with the Massachusetts State Health Department.

The pathology of five patients who had a biopsy in the acute stage is described; interstitial pneumonia, sarcoid-like granulomata, bronchiolitis, and vasculitis were found. Three of these patients progressed to the chronic stage, when the one with the most extensive bronchiolar involvement had lung function findings of airway obstruction. One progressed to the chronic stage with lung function findings of a transfer defect, and another had radiographic evidence of pulmonary fibrosis with normal lung function tests at rest. The pathology of the chronic stage is described in six patients, with necropsy findings in five. Interstitial pulmonary fibrosis, cystic change, and pulmonary hypertensive changes were the principal findings. [ABSTRACT FROM PUBLISHER]

The article presents a paper that reexamines the motor behavior of patients with chronic schizophrenics. The hypothesis is investigated that among chronic schizophrenic subjects a very underactive group exists who respond differently from others to incentives. Two groups were given a simple task and their performances measured. The more inactive group showed substantial improvement when it was subjected to a forceful stimulus, unlike normals. This group contained those with a history of catatonic episodes. The ideas of reference or delusions of persecution were compatible with a small beneficial response to the forceful regime but not with a great response.

Chronic renal failure precipitates a state of crisis for most patients and their families. This paper describes the contribution of the social worker in a renal unit operating a recurrent dialysis and renal homotransplantation program and shows some of the psychosocial and economic problems associated with chronic renal failure. [ABSTRACT FROM AUTHOR]

Presents case histories of patients with chronic hypertrophic gastritis. Results of the physical examinations; Laboratory findings; Pathologic examinations of the specimens.

The article presents a paper read at the Annual Meeting of the Dermatological Association of Australia in Perth, Western Australia which discusses the complications and indications with the use of corticosteroids, which are morbido-static and not curative drugs. Complications from its use include the disturbance of electrolyte metabolism, the reactivation of chronic infections and the production of psychosis. Moreover, it modifies the organism's capacity in responding to stress.

In spite of the awareness of chronic diseases over centuries, it has been difficult to make and implement significant victories in case-screening and treatment. It is suggested that perhaps more extensive use of an interdisciplinary approach, including new dimensions in social work, may help in overcoming these problems; e.g. professionals, the medical profession as well, viewing man as a product of socio-cultural influences and relating to him accordingly, thus, hopefully, enlisting greater cooperation from client-groups vulnerable to many such chronic diseases. This ‘model’ was probably first advanced by social workers. Perhaps we can make an even more worthy contribution by working jointly with professional and community groups to coordinate casefinding, better health-care services, and prevention of diseases, altogether representing expansion of the traditional role of ‘helper.’ [ABSTRACT FROM AUTHOR]

The article presents information on the research paper "Chlorambucil in Treatment of Chronic Lymphocytic Leukemia and Certain Lymphomas," by J.E. Ultmann and A. Gellhorn. It is highlighted in the paper that chlorambucil (CB 1348) which is an aromatic nitrogen mustard, is given orally and effective doses were found to be relatively free from side-effects, and rarely to cause bone marrow damage.

Hyperbaric oxygen at 2 atmospheres pressure was administered to nineteen cases of chronic varicose leg ulceration. Treatment was given for 2 hr on 5 days of each week. Bacterial infection of the ulcers was suppressed, and drying of the lesions occurred within hours of commencing treatment. Epithelialization of healthy granulation tissue was a constant feature. Simple venous ulcers consistently responded better than those cases where arterial insufficiency was present. No adverse reactions were observed. Seventeen of the nineteen patients had their ulcers healed after a mean exposure to OHP of 60·7 hr. [ABSTRACT FROM PUBLISHER]

An investigation of the occurrence of fluorosis and caries was carried out in districts in Sweden with extremely high fluoride (F) concentrations in the drinking water. In areas with ∼ 10 ppm F* severe fluorosis, DEAN'S Index Grade 3 and 4, occurred on all permanent teeth and most of the primary teeth. The fluorosis was related to the F supply during the period of mineralization of the teeth. One case of "delayed" fluorosis was, however, demonstrated. In the area ∼ 5 ppm, 50 % of individuals had fluorosis Grade 2 and 28 % Grade 3 or 4 in the permanent teeth. Fluorosis in the primary dentition was milder, but only 20 % of the individuals were completely free from fluorosis and several cases of Grade 3 and 4 occurred in this area also. Caries frequency in the permanent teeth was higher in the ∼ 10 ppm area in comparison with the ∼ 1 ppm area. The highest DMFS values could be related to fluorosis Grade 3 and 4 in both the ∼ 10 ppm and ∼ 5 ppm areas. For the primary teeth the deft value decreased with increasing water F content and the caries frequency was not related to the degree of fluorosis. Duration of breastfeeding influenced the degree of fluorosis in areas up to ∼ 5 ppm in both the primary and secondary dentitions; in areas with ∼ 10 ppm F only the primary dentition was influenced, while the permanent teeth in these areas showed severe fluorosis even with long duration of breastfeeding. F content of saliva was, like the F content of bone and blood plasma, increased in the ∼ 10 ppm area. F deposition in primary teeth from the ∼ 10 ppm area was of the order four times that in the ∼ 1 ppm area. Pre- and post-natal F deposition is discussed with reference to analyses of F content of blood and bone, and the significance of these factors during pregnancy. [ABSTRACT FROM AUTHOR]

Two siblings, a girl and a boy, and their mother were abnormally susceptible to infections with bronchopneumonias leading to chronic pulmonary atelectasis in the girl and otitis leading to necrotizing changes with deafness in the mother. The causative micro-organism most often found was Haemophilus influenzae. The serum IgG was within the normal concentration range, but showed restricted electrophoretic heterogeneity with absence of the anodal component. Serum IgG2 and lgG4 were absent. Absence of antibodies to teichoic acid and haemagglutinating antibodies to Haemophitus influenzae polysaccharide was noted as was the case with isohaemagglutinins and heteroagglutinins against sheep cells. Lymphopenia and poor [³H]thymidine uptake by peripheral lymphocytes after PHA stimulation were demonstrable in the girl and the mother. The girl had developed an epithelial ovarian tumour. The disease was a non-X-linked recessive and expressed selective humoral and selective cellular immunodeficiency. An inherited structural or regulatory gene defect is suggested. Gamma-globulin therapy had a good clinical effect. [ABSTRACT FROM AUTHOR]

Human lymphocytes which have been purified from mononuclear leucocyte suspensions by removal of cells which adhere to nylon fibres have a reduced blastogenic response to periodate treatment as compared to the whole cell suspensions. Incubation of the purified lymphocytes on macrophage monolayers markedly enhanced their response to periodate. Periodate-treated macrophages enhance the response of purified lymphocytes to periodate more than do untreated macrophages. Stimulation of thymidine incorporation into purified lymphocytes untreated with periodate. was also noted after their incubation on periodate-treated macrophage monolayers. Chronic lymphatic leukaemia lymphocytes which have an impaired blastogenic response to periodate can be stimulated by this agent upon incubation on macrophage monolayers. Alternatively untreated chronic lymphatic leukaemia lymphocytes are stimulated on incubation on periodate-treated macrophage monolayers. [ABSTRACT FROM AUTHOR]

, , 394-400. Chronic airflow obstruction may be due either to disease of the airway wall and lumen or to loss of airway-distending forces acting on the outer wall of the bronchus. In 17 patients with chronic airflow obstruction the relative importance of bronchial and extrabronchial factors was assessed by analysing the relation between airways conductance and static transpulmonary pressure over a range of lung volumes. Using previously established clinical, radiological, and functional criteria (which did not include measurements of the mechanical properties of the lungs), six of these patients had evidence of widespread emphysema and six patients had predominant `bronchial' disease. In four of the six `emphysematous' patients there was no functional evidence of disease of the bronchial wall or lumen during quiet breathing, and airway narrowing could be explained by loss of airway-distending forces. The six patients with characteristic `bronchial' features showed functional evidence of disease of the bronchial wall or lumen. [ABSTRACT FROM PUBLISHER]

The article assesses the effect of nurse intervention on patient compliance in an outpatient clinic treating various chronic diseases in the U.S. In this study, the researchers reported the consequences of one type of nurse intervention for selected attitudes and behaviors of black clinic outpatients. The results suggest that patient response to nurse intervention indicates less that the patient is complying with the expectations of a 'significant other' and more that the treatment process is providing meaningful ways for him to confront his illness.

Provides information on the clinical features of pancreatic inflammation. Localization of pain in pancreatitis; Relationship of the peritoneal symptoms to the level of serum amylase in patients with chronic pancreatitis; Clinical symptoms of the disease; Methods of palpation of the pancreas.

The article focuses on the research paper "Chloroquine Sulphate in Treatment of Chronic Discoid Lupus Erythematosus," by H.J. Lewis, which was published in a 1955 issue of the "British Medical Journal." It focuses on eighteen cases of lupus erythematosus which were treated with chloroquine sulphate. It is efficient as a form of palliative therapy.

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Much current research on organizational ideology has as its point of departure two assumptions which are sometimes correct and at other times erroneous. One is that the psychological meaning of organizational ideology corresponds to its sociological meaning, and the other is that such issues may be described in bipolar terms. The position is taken that a more fruitful approach would take these assumptions as empirical questions capable of being answered in specific instances. The study reported here examines the ideological issues confronting the rehabilitation personnel of a Midwestern chronic disease hospital in their work with physically disabled patients. A sociological analysis, based on perusal of the rehabilitation literature, indicated the existence of both a "traditional" and "progressive" viewpoint. However, factor analysis of the responses of the hospital personnel to attitude items showed the existence of four factors, named Patient-Rejection-Acceptance, Humanitarian Concern, Disenchantment-Hope, and Rejection of Pessimism. The extent of coincidence between psychological and sociological meanings, and the origins of multidimensional attitudes in rehabilitation is briefly discussed. [ABSTRACT FROM AUTHOR]

The article elucidates the diagnostic difficulties, and to describe the specific test data upon which diagnostic conclusion was based. This case history of a 57-year-old white, divorced school teacher has been presented as a problem in diagnosis of a chronic illness resistant to extensive treatment and labeled as functional. Considerations in the course of treatment led to a reassessment of the patient with psychological tests being utilized as an aid in this endeavor. The psychological examination, complementing the data derived from the interviews, facilitated the solution of the diagnostic problem with the identification of a major organic factor, hypothyroidism.

This article reports on some observations on patient government. In a small way, patient government, as practiced in the Continued Treatment Service of this hospital, seems to give the chronic patient an opportunity to again become an active participant in attempting to resolve his individual needs with the demands of his environment. The patients are exposed to a situation in which they recognize and discuss problems of living together, and attempt to apply their own solutions to them. They are able to see the results of their attempts to solve their problems, and regain some of their former problem-solving skills in an institutional setting.

The article focuses on the description of the disease known as erythema elevatum diutinum, based on the review made by H. Haber published in the British Journal of Dermatology. According to Haber, erythema elevatum diutinum appears frequently between the ages of 30 to 60 and impacts both male and female equally, which is also seemed to be chronic and continuous. Meanwhile, a case of a 45-year old woman with the said disease is presented, along with the results of her clinical investigations.

Lymphocytes from a ease of chronic lymphocytic leukaemia were found to contain crystalline protein inclusions within cisternae of rough endoplsmic reticulum. These inclusions were characterized as IgA λ immunoglobulin and differed from the immunoglobulins found at the surface of the cells containing the inclusions. No serum paraprotein was detected in the serum of the patient, although small amounts of λ light chain protein were present in the urine. These observations suggest that the crystalline immunoglobulin was not excreted in significant amounts by the lymphocytes. [ABSTRACT FROM AUTHOR]

In two patients presenting as chronic lymphocytic leukaemia, immunofluorescence studies have demonstrated the presence of an accumulated intracytoplasmic material reacting with antisera to μ chains and only to one type of light chains, whereas their serum contained neither monoclonal IgM nor free μ chains. In the first case, the IgM lambda inclusion bodies were crystals detected in the cytoplasm of small lymphocytes and were not clearly lined by rough endoplasmic reticulum. IgM λ molecules were present at the surface of the lymphocytes. In the other patient, who elaborated free K light chains, the inclusions found in marrow plasma cells and in peripheral blood lymphocytes were Russell bodies. The practical and theoretical importance of non-secretory immunoproliferative disorders, characterized by an unreleased monoclonal immunoglobulin marker, is outlined. [ABSTRACT FROM AUTHOR]

Radioisotopic scanning of brain, liver, lungs and the skeleton is briefly reviewed with a survey of recent developments of clinical significance. In brain scanning neoplasm detection rates of greater than 90% are claimed. The true figure is probably 70-80%. Autopsy data shows a number of false negatives, particularly with vascular lesions. Attempts to make scanning more specific in differentiating neoplasm from vascular lesions by rapid sequence blood flow studies are reviewed. In liver scanning by means of colloids again high success rate is claimed but small metastases are frequently missed and the false negative scan rate is probably quite high. Lung scanning still has its main place in investigating pulmonary embolic disease. Ventilation studies using Xenon 133 are useful, particularly combined with perfusion studies. The various radiopharmaceuticals for use in bone scanning are reviewed. The appearance of technetium labelled phosphate compounds will probably allow much wider use of total skeletal scanning. Research into tumour localizing agents continues, the most recent and interesting being Gallium citrate and labelled bleomycin. Neither agent is predictable however although Gallium may have a place in Hodgkins disease and bronchogenic neoplasm and both may have a place in the detection of cerebral tumours. [ABSTRACT FROM PUBLISHER]

A chronic degenerative neurological disorder is described which is characterized by tics, grimacing, involuntary movements, a severe disturbance of swallowing and a concurrent malformation of the erythrocytes. This condition is clearly different from familial hypo-betalipoproteinaemia and abetalipoproteinaemia, the two previously described neurological disorders associated with abnormal red cells. [ABSTRACT FROM PUBLISHER]

Chest radiographs of 101 patients with chronic airflow obstruction were assessed for evidence of over-inflation (increased retrosternal space, low diaphragm, and increased total lung capacity), pulmonary hypertension (increase in size of heart and major pulmonary vessels) and attenuation of medium-sized pulmonary vessels. The radiological abnormalities were related to the alterations in pulmonary function. When the position of the diaphragm was low or the retrosternal space was 4·5 cm or more the average FEV was below 1·0 litre, but severe impairment of the FEV could be present when the position and contour of the diaphragm were normal and the retrosternal space was 2·5 cm or less. The radiological method for estimating total lung capacity agreed well with the results obtained with body plethysmography, but there was not a close correlation between the standard radiological signs of over-inflation and a large total lung capacity. When the radiograph showed widespread vascular attenuation as well as over-inflation the impairment in FEV and other tests of pulmonary function was considerably more severe than when the radiograph showed over-inflation alone. Severe reduction in transfer factor was usually associated with changes in the pulmonary vessels. It is concluded that the radiological diagnosis of widespread emphysema can be made with confidence only when there is attenuation of pulmonary vessels as well as evidence of over-inflation. In attempting to diagnose emphysema in life all available clinical and functional data should be considered in conjunction with the radiographic appearances. [ABSTRACT FROM PUBLISHER]

The neuraminic acid content of sputum from 48 men with early chronic bronchitis has been estimated in samples collected over a period of three years. The results are compared with those from 29 advanced bronchitic patients and are related to the clinical features of both groups and to the physical and biological properties of the sputum. A seasonal variation in neuraminic acid content has been noted for the first time with higher levels during the winter months. Clinical assessment of sputum pourability correlated well with measured viscosity. The viscosity of mucoid sputum was related to its neuraminic acid content but also to the yield of dry macromolecular material. In the early bronchitic group whose sputum was assessed for purulence at monthly intervals pus was more often present in those men whose mucoid sputum contained higher levels of neuraminic acid. These findings are discussed in relation to the cause of exacerbations of chronic bronchitis. [ABSTRACT FROM PUBLISHER]

In a double-blind, controlled cross-over trial, the effect of the mucolytic drug bromhexine (24 mg or 48 mg daily) was compared with a placebo over a period of 14 weeks in 21 severe chronic bronchitics (mean FEV 0·8 1.). Each of the three treatment regimes was continued for four weeks with intervening single weeks on placebo tablets. As the subjects were outpatients, sodium fluorescein incorporated in the tablets was used as a drug marker. Satisfactory data were obtained in 18 patients. There was no significant improvement in clinical condition or ventilatory capacity nor change in sputum properties throughout the period of study. No side effects or significant change in blood values were detected. [ABSTRACT FROM PUBLISHER]

In a prospective study of 170 patients with various types of chronic liver disease, a pulmonary gas transfer defect was found in 20% and mottled shadowing in the chest radiograph in 6%. The presence of these abnormalities was not related to the cause of the liver disease. Reduction of transfer factor in liver disease was not accompanied by a restrictive ventilatory defect and was found in most cases with mottled radiographs. The incidence of finger clubbing and the levels of both venoarterial admixture and cardiac output were higher in patients with mottling than in those with normal radiographs. Mottling was also seen in the chest radiographs of five other patients with hepatic cirrhosis who had previously been investigated for cyanosis due to intrapulmonary shunting. Despite earlier reports of active chronic hepatitis and primary biliary cirrhosis occurring in patients with fibrosing alveolitis, we suggest that these radiographic changes in liver disease are usually caused by a pulmonary vascular disorder, rather than by coincidental lung disease, and are a local manifestation of a generalized vasodilated state. The low incidence of diffuse lung disease complicating chronic liver disease was confirmed by reviewing the hospital necropsy records. In one patient the radiographic mottling disappeared and the physiological evidence of a circulatory disorder became less marked during a period of improved hepatocellular function. [ABSTRACT FROM PUBLISHER]

Blood volume studies in chronic hypoxic lung disease have produced conflicting results. Some have demonstrated that the red cell volume-hypoxic relationship is similar to that in normal subjects, whereas others have found that it is subnormal. Plasma volume has not been shown to be related to hypoxia. To elucidate this further, 45 patients with chronic obstructive bronchitis were studied. They were on average hypoxic at rest and on exertion, but mean values of red cell volume, plasma volume, venous haematocrit, red cell count, and haemoglobin concentration were normal. Red cell volume was linearly related to the degree of hypoxia, but the response was subnormal. Arterial oxygen saturation rather than tension was the main determinant of red cell volume, and resting values correlated better than exercise values with red cell volume. The best correlations were obtained when red cell volume was expressed as a function of the lean body mass rather than the total body weight. Red cell volume was also linearly related to arterial Co tension. Plasma volume did not correlate with any of the blood gases. The subnormal polycythaemic response to hypoxia may have been caused partially by latent iron deficiency and chronic infection; but severe hypoxia, hypercapnia, and gastrointestinal bleeding were not aetiological factors. The importance of tissue hypoxia in the regulation of the erythropoietic response and the reasons why previous blood volume studies have produced conflicting results are discussed. [ABSTRACT FROM PUBLISHER]

An association between a genetically determined deficiency of the serum enzyme α antitrypsin and pulmonary emphysema is now well established. Serum antitryptic activity was measured in 103 patients suspected of having emphysema. Eighty-seven fulfilled the diagnostic criteria for emphysema and, of these, 16 had deficient levels, 5 had intermediate levels, and 66 had normal levels. The results of clinical, radiographic, and physiological studies in each group were then compared. Characteristic features noted in the deficient group included onset of dyspnoea during the third or fourth decades and uniformly symmetrical radiographic lower zone involvement. Other factors such as sex distribution, cigarette smoking, and chronic bronchitis are discussed. Sixty-eight relatives of the 16 patients with deficient levels were also studied. The findings in these are compatible with an autosomal recessive mode of inheritance although difficulties in identifying the heterozygous state were encountered. Six relatives had deficient levels and of these three had emphysema. [ABSTRACT FROM PUBLISHER]