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A patient with 7 yr of severe disabling chronic epigastric abdominal pain attributed to chronic pancreatitis was seen in consultation before a 95% pancreatectomy for pain control. Previous attempts to identify and treat the pain lead to extensive radiographic, pharmacological, endoscopic, and surgical interventions, including a Roux-en-Y pancreaticojejunostomy. Pain control was poor despite implantation of a continuous intrathecal morphine infusion pump. A focused physical examination, however, raised the suspicion of thoracic disc disease, which was confirmed after myelogram with computed tomography. Disruption of the T7-T8 disc with protrusion into the vertebral canal and displacement of the spinal cord with an associated bone spur were identified. A microsurgical thoracic discectomy was performed. Immediately, the pain began resolving, and she was pain free and off her medications within several weeks. To our knowledge, this is the first description of a herniated thoracic disc presenting as the pain of chronic pancreatitis. The diagnosis of thoracic disc syndrome requires a high index of suspicion and should be considered in patients with chronic abdominal pain.

Diclofenac sodium is a widely used enteric-coated nonsteroidal anti-inflammatory drug. We describe a woman with Hemoccult-positive stools and iron deficiency anemia who developed both a colonic ulcer and a "diaphragm-like" colonic stricture while taking enteric-coated diclofenac. These lesions were evident on colonoscopy but not on barium studies. Biopsy specimens of the ulcer and stricture revealed particulate matter that was indistinguishable from diclofenac pill fragments by electron microscopy. Discontinuation of diclofenac therapy resulted in resolution of anemia and Hemoccult-positive stools. We conclude that (1) enteric-coated diclofenac is associated with both colonic ulcers and diaphragm-like colonic strictures; (2) the pathophysiologic mechanism for the development of both ulcers and strictures may involve a direct action of diclofenac within these lesions; (3) colonoscopy may be superior to barium studies in evaluating patients receiving diclofenac who have iron deficiency anemia and/or Hemoccult-positive stools.

Previous research has suggested that certain social factors, e.g., dominance rank, can determine the behavioral effects of drugs in individual members of a social group. In the present experiment, the effects of d-amphetamine were studied in two adult male monkeys with dominance rankings that changed during a reorganization of the social hierarchy in a captive group of stumptail macaques (Macaca arctoides). A range of doses of d-amphetamine was administered to each subject, and dose-effect curves were determined before and after group reorganization and stabilization. The data revealed drug effects which were dependent upon dose and the social rank of the animals. When either subject occupied the highest ranking or alpha position within the dominance hierarchy, rate of aggressive behavior initiated by the subject was several times greater than when that monkey occupied a lower position within the dominance hierarchy. Moreover, for either subject, the dose-effect curve was shifted to the right when the monkey was highest in the dominance hierarchy. Finally, aggression initiated by the drug-treated subject was directed more frequently toward adult members of the group when the subject was highest in the hierarchy and toward nonadult animals when the subject was lower in the hierarchy. These data support the hypothesis that the dominance position of an animal in a group can be a determinant of the behavioral effect of certain drugs.

Lower incidence rates of cancer for all anatomic sites combined were found in male and female Spanish-surnamed residents of Los Angeles County when compared to other whites. These Mexican-Americans were at lower risk for cancer of the buccal cavity, colon, rectum, larynx, lung, breast, bladder, prostate, and testis, and were at higher risk for cancer of the stomach, gallbladder, liver, and cervix. Immigrant Mexican-Americans had incidence rates most divergent from other whites, whereas indigenous Mexican-Americans had rates between the other two groups. The cancer pattern in Mexican-Americans was generally similar to that in American Indians. These data were most consistent with environmental variations in cause.

Public sector spending and private sector spending for health and medical services have tended to parallel one another over the past four decades. Although total expenditures have grown dramatically, the relationship between the two sectors has not. Government gradually increased its support and provision of health care between 1929 and 1940. Between 1940 and 1966 government spending for health care remained at a plateau. The federal government's major participation since 1966 has been through its role as a transfer agent for the Medicare trust fund, acting as an intermediary, rather than through the expenditure of general revenues for health and medical care services. Rising costs and increased demand for medical services will probably force a larger financial role upon government.

A cancer Surveillance Program was formed in 1970 to provide a mechanism for the early identification of some 22,000 cancer cases that are diagnosed annually among the large and varied population of Los Angeles County. The program's rapid reporting procedures facilitate early access to patients for interviewing and specimen collection. Routine review of all reports of microscopically diagnosed malignancies in hospitals throughout the county and screening of all of the county's death certificates provide virtually complete data on cancer incidence in the county. Case reports include information on age, ethnic group, birthplace, residence, religion, marital status, occupation, and industry. Continuing analysis of this information has led to the development of epidemiologic studies of several factors which may have an etiological relationship to human cancer. Among these factors are genetic susceptibility, exposure to air pollutants and industrial carcinogens and possible viral transmission.

An increased rate of lung cancer has been consistently observed from 1968-1972 among males in southcentral Los Angeles. This excess risk occurs across several social classes and occupational categories. No differential excess of oral cavity, pancreatic, laryngeal and bladder cancer was observed in the same area, lessening the possibility that regional variations in smoking habits accounted for the excess lung cancer. Air sampling has indicated an excess of certain polynuclear aromatic hydrocarbons (PAH) in southcentral Los Angeles. There was a correlation between the geographic distribution of lung cancer cases and the general location of industries which have emitted these PAH. A case-controlled study of smoking, occupational and residential history in the southcentral area is underway.

Data from the Los Angeles County Cancer Surveillance Program (CSP) from 1972 to 1975 were used to study the descriptive epidemiology of testicular cancer and prostatic cancer. The very high black/white ratio and late age peak of cancer of the prostate contrasted sharply with the very low ratio and early age peak of testicular cancer. However, both sites had higher rates among upper occupational and social class groupings. Avalable descriptive and analytical research suggests that the etiology of prostatic cancer is most probably related to hormonal influences rather than to a horizontally transmitted agent, while the etiology of testicular cancer is most probably related to endogenous or exogenous hormonal influences in utero or in infancy, or to in utero exposure to other exogenous agents.

1. By a method of hepatic venous catheterization previously described, comparative data have been obtained concerning the removal of pneumococci from the splanchnic circulating blood of the intact rabbit in bacteriemias secondary to a dermal infection and in bacteriemias induced by a continuous infusion of organisms into the blood stream. The average splanchnic removal in secondary pneumococcal bacteriemias was 8 +/- 14 per cent (S.D.), in induced bacteriemias 9 +/- 15 per cent (S.D.). 2. Similar data were obtained in induced M. aureus bacteriemias in normal rabbits and in induced M. aureus bacteriemias superimposed upon pneumococcal bacteriemias secondary to dermal infection. The average splanchnic removal of M. aureus in normal rabbits was 62 +/- 20 per cent (S.D.). The splanchnic removal of M. aureus in rabbits with a simultaneous pneumococcal bacteriemia of infection was of the same order of magnitude as in normal rabbits. 3. The efficiency of the mechanism of splanchnic removal for a given organism is an important factor in the establishment and maintenance of a bacteriemia. Present evidence indicates that the maintenance of a bacteriemia requires a constant introduction into the blood stream of organisms from some source. 4. Pneumococci do not acquire a resistance to removal from the splanchnic circulating blood during the course of fatal infection in rabbits. 5. No final exhaustion of the mechanism of splanchnic removal can be demonstrated in fatal pneumococcal bacteriemias in rabbits.

A description is given of a slide cell whereby the rate of migration of very small amounts of leucocytes can be followed and measured. The migration of polymorphonuclear leucocytes was found to be inhibited by virulent tubercle bacilli pathogenic for the class of animal (mammal or bird) from which the leucocytes were obtained; it was not affected by the avirulent variants of these microorganisms, or by bacilli pathogenic for animals of the other class. Tests failed to disclose that the inhibition of leucocytic migration resulted from any gross damage caused by the bacilli to the leucocytes.

The alterations in succinic dehydrogenase activity during the course of infection with Mycobacterium tuberculosis strains H37Rv and BCG, as well as with dead bacilli, has been described. A tissue factor has been described which is prepared from normal bovine kidney and will restore enzyme activity in vitro. This factor is prepared by chromatographic analysis and contains a nucleotide with an ultraviolet absorption maxima at 250 mmicro (pH 3) and a free sulfhydryl group. The role of this factor in the response to tuberculosis is discussed.

The kidney of guinea pigs infected with the H37Rv and BCG strains of M. tuberculosis showed a diminution in succinic dehydrogenase activity when measured by the tetrazolium technique. This effect was also seen in the liver and spleen of animals infected with the BCG strain. Sensitized animals showed similar results when given tuberculin in sublethal doses. The succinic oxidase was also low in the kidneys of animals infected with the H37Rv strain. The depressed enzyme activity of the tissues of infected animals could be restored to normal by addition of normal tissue extract or dialysate. This suggests that the alteration in tissue metabolism observed in tuberculosis may depend upon the loss of some as yet unidentified factor important for succinic dehydrogenase activity.