Search

To evaluate earlier observations, including our own, showing usefulness of vitamin C for managing the common cold, we performed a double-blind trial of vitamin C versus placebo in 868 children. There was no difference in number becoming ill (133 versus 129), number of episodes (166 versus 159) or mean illness duration (5.5 versus 5.8 days) between the groups. Children receiving vitamin C had fewer throat cultures yielding beta-hemolytic streptococcus (six versus 13, P less than 0.10), but no difference in overall complicated illness rate (24 versus 25). Plasma ascorbic acid levels were higher in the vitamin group 24 to 26 hours after supplementation (1.28 versus 1.04 mg per 100 ml, P less than 0.01). Children with high plasma ascorbic acid concentrations had longer mean illness (6.8 versus 4.0 days, P less than 0.05) than those with low levels. Vitamin C does not seem to be an effective prophylactic or therapeutic agent for upper respiratory illness.

To learn whether chronic otitis media with effusion during early life has lasting otologic, audiologic, or developmental consequences, we evaluated 24 closely matched pairs of children with repaired palatal clefts whose treatment had been equivalent except with regard to persistent otitis media during early life. One group had undergone early (mean age, 3.0 months) myringotomy with placement of tympanostomy tubes, followed by assiduous monitoring and an aggressive treatment program to maintain ventilation in the middle ear. The other group had undergone initial myringotomy later (mean age, 30.8 months) or not at all (two subjects) and presumably had had continuous middle-ear effusion throughout most or all of the first few years of life. Eardrum scarring was equal in both groups. Hearing acuity and consonant articulation were impaired in both groups, but hearing acuity was less impaired (P = 0.05 to 0.10) and consonant articulation significantly less impaired (P = 0.03) in the group undergoing early myringotomy. Mean verbal, performance, and full-scale IQs and scores on psychosocial indexes were normal in both groups and did not differ significantly between the groups. These findings support the hypothesis that early, longstanding otitis media may result in impairment of hearing and of speech, but they do not support the hypothesis that cognitive, language, and psychosocial development are adversely affected.

A total of 112 patients with the diagnosis of nonfunctional pituitary adenoma received radiation therapy at the University of Pittsburgh between 1964 and 1987. Postoperative radiation therapy was administered in 87 patients. Actuarial progression-free survival (tumor control) at 5, 10, 15, and 20 years was 97%, 89%, 87%, and 76%, respectively. Radiation prescribed to the 95% isodose ranged from 35.72 Gy to 62.32 Gy. Multivariate analysis showed decreased tumor control to be significantly associated with increasing field size (P = .036). No improvement in tumor control could be detected with increasing total radiation dose or nominal standard dose (NSD). One patient developed optic neuropathy and another developed a glioblastoma after doses in both patients of 4750 cGy in 25 fractions. External beam radiotherapy for nonfunctional pituitary adenomas was found to be effective and safe when doses less than 4750 cGy in 25 fractions were used.

In a large double-blind study among Navaho school children, we evaluated the effects of vitamin C in 1- and 2-gram daily doses on acute respiratory illness during a 14-week period.' We found no evidence of significant prophylaxis, but our findings did suggest a modest therapeutic benefit in that children taking vitamin Chad from 28% to 34% fewer days of morbidity caused by respiratory episodes than those taking placebo. Likewise, in classroom surveillance, younger children on vitamin C had 26% fewer symptom-days of cough and nasal discharge recorded. These observations were consistent with other recent trials using 1 gram daily (4 grams during illness) in Canadian adults L' and 250-500 milligrams daily in Irish schoolchildren.3 The clinical significance of this modest therapeutic result in minor, selflimited illness was, in itself, questionable. However, further study was indicated to determine: (a) if use of vitamin C could prevent complications of the common cold in children, such as superinfections or otitis media; (b) if certain symptoms or symptom complexes responded specifically to vitamin C therapy; and (c) if indeed, as our data had suggested,l higher blood ascorbic acid levels were correlated with fewer days of illness. A second investigation was designed to confirm, if possible, and expand our previous findings. The second trial was conducted in two Navaho boarding schools during January through May 1974, using doses of 1 gram vitamin C daily versus placebo tablets. This report presents preliminary routine surveillance findings from the second study.

In a double-blind study, 74 children were randomly treated with prophylactic methicillin at the time of ventriculo-peritoneal shunting. There were 7 infections in the placebo group and 2 in the methicillin-treated group. There was no statistically significant difference in infection or overall malfunction rate between the two groups. The risk of shunt malfunction in the 2nd to 6th month after surgery was significantly greater in the placebo group (7 of 26 patients) than in the methicillin-treated group (1 of 26 patients). Delayed shunt malfunction may be prevented by a short course of perioperative antibiotics.

Thirty normal males and 30 normal females who were between the ages 10–14 yr inclusive, who on careful physical examination ranged from prepubertal to adult sexual development (Tanner Stages I–V) were each studied by measuring serum FSH, LH, estrone (E1) and estradiol (E2). Prepubertal females (Stage I) had higher values for estradiol, 10 pg/ml than males, 5 pg/ml (p < 0.005). Estrone was not significantly higher in prepubertal females. At each subsequent stage of puberty, both E1 and E2 were significantly higher in the girls (p < 0.05). Both estrogens correlated significantly with stage of puberty, osseous maturation, and with chronologic age in males and females. A significant association (p < 0.05) was observed between levels of both gonadotropins and levels of both estrogens in males, and between both gonadotropins and E1 in females; E2 correlated significantly with LH (rs = 0.7), but poorly with FSH (rs = 0.13).

Young dystrophic (dy) murine muscle is capable of ( spontaneous) regeneration (i.e., regeneration in the absence of external trauma); however, by the time the mice are 8 weeks old, this regeneration ceases. It has been suggested that the cessation of regeneration in dystrophic muscle may be due to exhaustion of the mitotic capability of myosatellite cells during the early stages of the disease. To test this hyptothesis, orthotopic transplantation of bupivacaine treated, whole extensor digitorum longus muscles has been performed on 14 to 16-week-old 129 ReJ/++ and 129 ReJ/dydy mice. The grafted dystrophic muscle is able to produce and maintain for 100 days post-transplantation 356 ± 22 myofibers, a number similar to that found in age-matched dystrophic muscle. The ability of old dystrophic muscle to regenerate subsequent to extreme trauma indicates that the cessation of ( spontaneous) regeneration is due to factor(s) other than the exhaustion of mitotic capability of myosatellite cells. Moreover, there is no significant difference in myosatellite cell frequencies between grafted normal and dystrophic muscles (100 days post-transplantation). Myosatellite cell frequencies in grafted muscles are similar to those in age-matched, untraumatized muscles. While grafting of young dystrophic muscle modifies the phenotypic expression of histopathological changes usually associated with murine dystrophy, grafts of older dystrophic muscle show extensive connective-tissue infiltration and significantly fewer myofibers than do grafts of age-matched normal muscle. As early as 14 days post-transplantation, it is possible to distinguish between grafts of old, normal and dystrophic muscles. It is suggested that the connective tissue stroma, present in the dystrophic muscle at the time of transplantation, may survive the grafting procedure.

Experimental studies in rats showed that immunization of the pregnant female led to the transplacental immunization of her fetuses. The possibility that this also occurred in humans was explored by immunizing 42 pregnant women with tetanus toxoid (2.5 or 5 Lf) in the fifth and eighth months of pregnancy and comparing the immune responses of their offspring with the responses of the offspring of 25 unimmunized mothers. Only the offspring of the immunized mothers were sensitized to tetanus. IgM antitetanus antibodies were in their blood before immunization with diphtheria, pertussis, tetanus vaccine (DPT), they had a more rapid (P less than 0.01) response to DPT immunization, and they were still highly sensitized (P less than 0.01) to tetanus 13 mo after birth. In addition, pregnancy had no immunosuppressive effect (P less than 0.05) on the responses of the mothers to tetanus toxoid. Thus, transplacental immunization occurs in humans; it enhances the response of the offspring to subsequent immunization, and it could be used to circumvent the necessity for immunization in early neonatal life.

The linkage of the major histocompatibility complex (MHC) and the growth and reproduction complex (Grc) in the rat was studied in an F2 hybrid population generated from female BIL/1 (RT1l-Grc) and male YO (RT1u-Grc+) animals: 1.722 offspring were born, and 1,568 were weaned and studied. The body weights of the offspring segregated with the RT1 haplotype of the MHC, and the RT1l homozygotes were significantly smaller than their RT1l/u and RT1u/u littermates. The growth rate of the RT1l/l animals was approximately the same as that of the BIL/1 animals, and both were significantly less than the growth rates of the RT1l/u, RT1u/u, and YO (RT1u) animals. The testes of the RT1l animals showed an arrest of spermatogenesis at the early pachytene stage of the primary spermatocytes, and they were approximately 1/10 as heavy as the testes of the RT1l/u and RT1u/u animals. The ovaries in females of all three haplotypes had the same weight, but there was a decrease in the number of ova released per cycle in the RT1 l/l animals. The major loss of the RT1l homozygotes, which caused distortion of the phenotypic ratios among the offspring, did not occur in utero but in the early postnatal period before weaning. There were 7/1568 recombinants between the MHC, using the RT1.A antigen as the marker, and the Grc, using small body size (dw-3) as the marker, and 1/1568 recombinant between the loci influencing body size (dw-3) and fertility (ft) of the Grc. These data gave the following map distances (95% confidence levels): RT1.A to dw-3, 0.45 (0.25-0.96) centimorgans and dw-3 to ft, 0.07 (0.04-0.40) centimorgans. A female recombinant was used develop an inbred line carrying the RT1.Al-Grc+ chromosome.

In an effort to better understand the relationship existing between lipoprotein pattern and longevity, we studied the lipid and lipoprotein distribution of 94 men over age 80 who lived in a nursing home, and assessed the role of selective mortality, body mass and sex hormone secretion in determining these distributions. High density lipoprotein subfraction and serum testosterone measurements were obtained on subsamples. The main findings were: (a) Presence of a lipoprotein pattern characterized by low LDL (total serum cholesterol: 179.6 +/- 36.0 mg/dl; LDL cholesterol: 106.3 +/- 31.2 mg/dl) and high HDL2 cholesterol (18.5 +/- 10.2 mg/dl) levels. (b) Occurrence of a positive association between LDL and HDL3 (r = 0.51, P less than 0.01), resulting in an overall high HDL2/HDL3 ratio. Mortality over a 6-month period was directly related to LDL level and possibly inversely related to HDL2 level, suggesting that selective mortality played a major role in determining the pattern observed. Body mass and serum testosterone concentration, which tended to be low, were independently correlated with lipoprotein level; a particularly strong correlation (positive) existed between free testosterone and triglyceride (r = 0.68, P less than 0.01). The latter results suggest that changes related to senescence also influenced lipid and lipoprotein levels.

The optimal sequence for clinical utilization of combined radiotherapy and hyperthermia is not known. The clinical trials have resulted in similar responses whether hyperthermia is given before or after radiation. Moreover, studies addressing the best sequence for an entire course of multifractionated hyperthermia and radiation are lacking. In these experiments, the importance of sequencing of heat and irradiation in a multifractionated treatment regimen in RIF-1 murine tumors was studied. It was observed that a close sequence of heat and irradiation is more beneficial than separate cytotoxic action. When heat and irradiation were given simultaneously, (within 1 hour) 67% to 75% of the tumors were cured. Heat and irradiation given sequentially (the entire course of one following the entire course of the other, each separated by 72 hours) cured 20% of the tumors. No tumors were cured when treated with heat or irradiation alone. The tumor regrowth time (mean tumor doubling time) is much longer in simultaneous treatment than in sequential treatment. It appears that heating first decreases the effectiveness of subsequent irradiation, causing a shorter growth delay than the opposite sequence. Heat alone does not alter the tumor bed permanently, but irradiation seems to do so, resulting in a slower rate of growth upon recurrence.

This study was undertaken to compare prospectively the frequency, nature, and severity of infections experienced by children in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for 12 to 18 months. At entry there were 159 children in home care, 40 in group care, and 45 in day care. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Severe illnesses were defined by high fever, duration exceeding 10 days, or physician visit. Children remaining in their original child care group for at least 1 year were compared with regard to the frequency and severity of illness. Children in group care and day care were more likely than children in home care to experience at least six respiratory infections, more than 60 days of illness, and more than four severe illnesses (P less than 0.01). Similarly, life table analyses showed that children in home care had fewer episodes of infection than did children in day care (P less than 0.01). Although no children were hospitalized because of acute infections during the first year of study, hospitalization for myringotomy and tube placement occurred in 21% of children in day care and 3% of children in home care (P less than 0.01).

As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy. (N Engl J Med 298:409–413, 1978)

An epidemiological link was found between contamination of a hospital water-supply by Legionella pneumophila and by Pittsburgh pneumonia agent (PPA) and subsequent cases of nosocomial legionnaires' disease and Pittsburgh pneumonia. The extent of L pneumophila isolation from the water-supply paralleled the occurrence of disease. Whenever L pneumophila was isolated from more than 30% of ten selected water sites, nosocomial legionellosis occurred. The temperature of the hot water tanks was raised to 60-77°C for 72 h, and water outlets were flushed for 30 min with hot water. A decline in numbers of L pneumophila and PPA in the water-supply was followed by a fall in the incidence of legionnaires' disease and Pittsburgh pneumonia. In addition, intermittent raising of the temperature in the hot water system decreased both the number of months in which disease occurred and the proportion of nosocomial pneumonias caused by these organisms.

The ability of exogenously administered N6, O2′-dibutyryl analogue of cyclic AMP to shorten, in a dose-related manner, the duration of narcosis of eight structurally different agents (chloral hydrate, paraldehyde, diazepam, amobarbital, halothane, ketamine, ethanol and methanol) has been demonstrated in the rat. No other nucleotide, neurotransmitter, biogenic amine or hormone tested, shortened, in a dose-related manner the sleeping time induced by the anaesthetic agents.

This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.

Altered carbohydrate metabolism associated with fibrosarcomas and chondrosarcomas has been well-documented in past literature. This report describes abnormal carbohydrate metabolism in 2 osteosarcoma patients, and abnormalities in growth hormone and somatomedin serum levels. Experimental evidence is presented showing in vitro suppression of osteosarcoma tumor cell proliferation by 17 beta Estradiol. Estrogen inhibition of linear bone growth, cartilage proliferation, and somatomedin is discussed with reference to possible estrogen therapy in osteosarcoma.

We hypothesized that when the depth of ether anesthesia is increased from 2 to 5%, cerebral vessels dilate secondary to circulating catecholamine stimulation of cerebral metabolism. Cerebral blood flow (CBF) by 133Xe clearance and cerebral metabolic rate for oxygen (CMRO2) were measured on 2% and then 5% ether in air in two groups of seven monkeys each during mechanical ventilation. Propranolol, 0.5 mg/kg i. v., was infused over 5 min in one group, and the other received saline. All measurements were repeated on 5% and 2% ether. Cerebrovascular resistance (CVR) fell by 30%, from 2.28 2± 0.61 (mean ± SD) to 1.51± 0.28 mm Hg ml−1 100 g−1 min−1 (p < 0.01), with the increase in ether from 2 to 5%. CBF and CMRO2 were unaltered from values of about 45 ml 100 g−1 min−1 and 2.3 ml 100 g−1 min−1, respectively. During 5% ether anesthesia, propranolol had no effect on CBF, CMRO2, or CVR. On 2% ether, it increased CVR twofold, from 1.5 ± 0.30 to 3.0 ± 1.0 mm Hg ml−1 100 g−1 min−1, and decreased CBF by 33%, from 48 ± 8 to 32 ± 10 ml 100 g−1 min−1. Plasma epinephrine was twofold higher on 2% compared to 5% ether, both before and after saline or propranolol infusion. In monkeys, cerebrovascular dilation by ether at 5% compared to 2% is not secondary to catecholamine stimulation of CMRO2. It may result from a direct effect of either plasma catecholamines or ether on the cerebrovasculature.

Three doses of amobarbital, an anesthetic dose (80 mg/kg), a minimum lethal dose (130 mg/kg), and a high lethal dose (180 mg/ kg) were administered intraperitoneally to groups of rats. All rats were injected intracerebroventricularly with 0.9% saline or dibutyryl cyclic AMP, 200 μg/rat. While those rats treated with saline solution were still sleeping at decapitation and those treated with dibutyryl cyclic AMP were awake, there were no significant differences in their brain concentrations of amobarbital.

The effect of incomplete penetrance of monofactorial recessive trait on the frequencies of sib-pair types in a random mating population has been examined. A method of estimating the gene frequency and the penetrance percentage from sib-pair data is given and illustrated by two numerical examples. The difficulty in interpreting the sib-pair data on rheumatoid arthritis in the Blackfeet Indians has been discussed.

Follicle-stimulating hormone (FSH) and luteinizing hormone (HL) assays of sera from girls with premature thelarche (26 4-month-old to 7-year-olds) sexual precocity (20 2-8 year olds) and premature adrenarche (5 5-8 year olds) were compared with those of normal girls. In the cases of sexual precocity there was a corresponding increase in FSH and LH which may have caused the precocity. There was a slight increase in hormonal levels in premature thelarche. In premature adrenarche there was a slight suppression of the hypothalmic pituitary-gonadotropin release mechanism.

Utilizing an in vivo isotope dilution technique based on 48 hr urine pools, cortisol production rates (CPRs) and urinary 17-hydroxycorticosteroids (17-OHCS) were estimated in 16 infants and children with hypothyroidism, and in 9 children and young adults with hyperthyroidism. The results were compared statistically with those obtained in 20 normal infants, children and young adults previously reported. Hypothyroid patients between the ages of 5 and 17 yr had a decrease in both CPR and 17-OHCS. However, 3 athyreotic cretins, less than 3 months old, and a mildly hypothyroid older infant had normal CPRs. In the hypothyroid patients there appeared to be a correlation between the duration and degree of hypothyroidism and the degree of depression of the CPR. Hyperthyroidism in the age group 5–17 yr induced a marked increase in CPR in only a few patients, while increasing the urinary 17-OHCS to a greater extent and with greater regularity.

Cortisol production rates (CPRs) and urinary 17-hydroxycorticosteroid (17-OHCS) excretion were studied in 13 subjects in mid- and late pregnancy and compared with those of nonpregnant women. CPRs and 17-OHCS were significantly lower (p

Adrenal function in six obese adolescents was evaluated by estimation of cortisol secretion rate (CSR) and urinary 17-hydroxycorticosteroid excretion (17-OHCS). CSR and 17-OHCS were elevated in comparison to nonobese adolescents (p p

An abbreviated three-dimensional checkerboard titration method was devised to determine whether synergistic interaction of three antimicrobial agents could be found against multidrug-resistant bacteria. Pseudomonas maltophilia was used as the test organism because of its resistance to most commercially available antimicrobial agents, including those active against Pseudomonas aeruginosa. Three-dimensional isobolograms with concave surfaces were formed when synergy occurred. Triple combinations of gentamicin-carbenicillin-rifampin (mean fractional inhibitory concentration index, 0.32) and trimethoprim/sulfamethoxazole-carbenicillin-rifampin (mean fractional inhibitory concentration index, 0.18) were consistently synergistic against 14 clinical isolates of P. maltophilia.

✓ This study was performed to determine if cerebrospinal fluid (CSF) shunts inserted via the frontal and parietal regions function for similar lengths of time. The medical records of 114 children with CSF shunts were reviewed. In 83 of these cases computerized tomography scans were also available. Ninety percent of the operations were to insert the child's first shunt. The site of insertion, cause of hydrocephalus, patient's age, surgeon, duration of function (time from insertion to malfunction or to latest follow-up evaluation), presence of infection, catheter location within the ventricle, and duration of function of the subsequent shunt were recorded. Data were analyzed by the chi-square, logistic regression, and life-table methods. Shunts had been inserted via the frontal route in 62 children and via the parietal route in 52. The children's ages, causes of hydrocephalus, and infection rates were similar in both groups. Duration of shunt function was predicted by the site of shunt insertion and the catheter position within the ventricles: shunts inserted via the frontal region functioned significantly longer than parietally inserted shunts, both as the initial shunt (Wilcoxon, p = 0.0008) and after a malfunction, and catheters positioned within the ipsilateral frontal horn functioned significantly longer than those in other ventricular locations (Wilcoxon, p = 0.03).

• Treatment outcome was correlated retrospectively with blood transfusions received in 179 surgical patients with stage III squamous cell carcinoma of the head and neck. Seventy-three percent of patients requiring no blood transfusion survived three years with no evidence of disease (NED). By comparison, patients receiving 3 or 4 U of transfused blood experienced a 47% three-year NED survival. Patients receiving 5 U or more of blood perioperatively experienced a 40% two-year NED survival. Seventy patients underwent surgery and postoperative radiation therapy. Life-table analysis demonstrated statistically significant differences in survival for patients who received 2 U or fewer of blood when compared with patients who received more than 2 U. These differences were not present in patients having surgery subsequent to previous radiation therapy or surgery alone. Blood transfusion may be detrimental to the management of patients with malignant neoplasms. The mechanisms through which blood transfusion affects malignant neoplasm is unknown. (Arch Otolaryngol Head Neck Surg1987;113:307-310)

Cultured human adrenal cortical adenocarcinoma cells (SW-13) form a confluent monolayer of epithelial-like cells when seeded into culture flasks. Following a 24-48 hr non-mitotic period, cells begin to divide and become confluent within a week after seeding at 5 X 10(4) cells/cm2. The SW-13 cells were exposed to dibutyryl cyclic AMP (DbcAMP), cyclic AMP (cAMP), sodium butyrate, and adrenocorticotropin (ACTH). The rate of SW-13 cell proliferation was measured with a DNA microfluorometric assay, as well as by procedures measuring the incorporation of 3H-thymidine. In addition, following administration of ACTH and DbcAMP, the fractional area of membrane covered by gap junctions was quantitated with freeze-fracture electron microscopic techniques. Dibutyryl cyclic AMP at a concentration of 1 X 10(-3) M decreased the growth rate of the cell population. There was a corresponding increase in the fractional area of gap junctions found on the cell membrane in 96-hr DbcAMP-treated cultures. ACTH (40 mU/ml) exposure failed to produce an increase in the fractional area of gap junctions or to alter the rate of cell proliferation. From these data it can be suggested that elevations in cAMP levels within the cell can be related to both the proliferation of gap junctions and the decrease in cell proliferation in the SW-13 tumor cell.

Patterns of growth and regeneration in 2-, 4-, 8-, and 17-week-old murine dystrophic (129 ReJ dy/dy) extensor digitorum longus muscles have been determined. Necrosis and myofiber loss, hypertrophy, and regeneration result in a reduced population of myofibers whose diameter distribution is more extensive than that found in the extensor digitorum longus muscles of age-matched normal mice. At the onset of dystrophic symptoms (2 weeks postnatal), the ratio of myosatellite cell nuclei to the total sublaminal nuclear population (myonuclei + myosatellite cells) is similar to that found in 2-week-old control muscles. The frequency of finding myosatellite cells decreases with age in both control and dystrophic muscles. Myosatellite cells account for 11%, 6%, 5%, and 3% of the total sublaminal nuclear population in control muscle and 12%, 8%, 6%, and 5% of the total sublaminal nuclear population in dystrophic muscle at 2, 4, 8, and 17 weeks, respectively. No preferential association of myosatellite cells with myofibers of a particular diameter is found in control muscle or in the two youngest dystrophic groups. At 8 and 17 weeks, myosatellite cells are less frequently encountered on small-diameter, regenerating myofibers of dystrophic muscle, and they are preferentially associated with large diameter, hypertrophied myofibers. The labeling index of myosatellite cells decreases with age in both normal and dystrophic muscle. At all ages the myosatellite cell labeling index is higher in dystrophic muscle (23%, 7%, 5%, and 2% at 2, 4, 8, and 17 weeks, respectively) than in normal muscle (5%, less than 1% at 2 and 4 weeks, respectively), with no labeled myosatellite cells being found in 8- and 17-week-old normal muscles. It is suggested that the magnitude of the regenerative response of dystrophic murine muscle decreases with age and that this factor may be responsible for the inability of the regenerative response of dystrophic muscle to keep pace with the rapid muscle deterioration.

• We compared selected neonatal characteristics of 40 children who were abused and neglected (34) or who failed to thrive (six) and 40 nonabused, thriving children individually matched by hospital of birth, gender, mother's welfare status, race, and age at which abuse or failure to thrive was manifested. The populations were preponderantly lower-class, black, and male. The following characteristics were overrepresented in the study population: birth order second or later, low birth weight, admitted to neonatal intensive care unit, and discharged from hospital after mother. The higher incidence of full-term infants who were small for gestational age for the study population (20%) than for the control population (3%) was of borderline significance. The lower distribution of birth weights in relation to expected birth weights for the full-term study subjects, however, was highly significant. ( AJDC 1985;139:295-298)

We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.

Like dibutyryl cyclic AMP, thyrotropin releasing factor (TRF) has potent antianesthetic properties, but only dibutyryl cyclic AMP shortens narcosis dose-relatedly. In contrast, only TRF reverses amobarbital-induced hypothermia (dose-relatedly). In naive rats, dibutyryl cyclic AMP (25-200 mug) induces convulsions while TRF (5-100 mug) produces intermittent hyperactivity and sedation but never convulsions. To determine whether behavioral events may be regulated in the central nervous system through an interaction of the two naturally occurring compounds, TRF (5-100 mug) and dibutyryl cyclic AMP (25-200 mug) were injected simultaneously into the lateral ventricle of the brain of naive rats or rats anesthetized with amobarbital (80 mg/kg). TRF (12.5-50 mug) and dibutyryl cyclic AMP (100-200 MUG) DID NOT SHORTEN NARCOSIS FURTHER THAN DIBUTYRYL CYCLIC AMP alone. Amobarbital protected against the lethal effects of the two compounds injected simultaneously. Long-lasting locomotor disorders and mortality rate increased with increasing doses of TRF (12.5-25 mug) and dibutyryl cyclic AMP (100-200 MUG) GIVEN TO NAIVE RATS. Results did not support the postulate that cyclic AMP is the second messenger of TRF.

The ability of intracerebroventricular exogenous administration of N 6 ,O 2 '-dibutyryl analog of adenosine 3':5'-cyclic monophosphate (db cyclic AMP) to shorten the duration of amobarbital anaesthesia in a dose-related manner has been shown in the rat. Alteration of the duration of sleeping time (ST) appeared to be specific to db cyclic AMP since neither adenosine nor guanosine nucleotides administered intracerebroventricularly produced any appreciable effects. Similarly, intracerebroventricular injected succinate or pyruvate did not alter amobarbital-induced ST. None of the behavioral symptoms observed following the intracerebroventricular injection of db cyclic AMP in the unanaesthetized conscious rat were evident in the amobarbital-anaesthetized rat.

Whereas aldosterone secretion changes little during growth and adrenal androgen excretion rises sharply at adolescence, cortisol production rate (CPR) increases gradually during growth and declines in old age. Previously published data on CPR obtained in our laboratory by an in vivo isotope dilution technique, in 96 subjects from birth to age 20 years, were recorrected for body surface area (/m2), body weight (/Kg.) and creatinine excretion (/Gm. cnne), i.e., muscle mass. The highest CPRs on the basis of /m2, /Kg., and /Gm. cnne were in babies under age 5 days, and the second highest values in the period 5–20 days. There-after in the age groups 20 days-5 years; 5–10 years; 10–15 years; and 15–20 years body surface area was the best predictor of CPR which decreased relative to muscle mass. In contrast to CPR, urinary 17-hydroxycorticosteroid (17-OHCS) excretion, (i.e., β-glucuronidase released Porter-Silber chromogens) was lowest in the age group less than age 5 days, and was still lowest when adjusted /m2. The recovery of 4-14C-cortisol metabolites in a “nonpolar”, conjugated (β-glucuronidase released chloroform extractable) fraction was also lowest in that age group. Nonconjugated “polar” metabolites were significant in the neonatal period. The data fail to elucidate the primary stimulus(i) for the changing rate of CPR from birth to age 20 years. However, they provide guidelines for the interpretation of adrenal function studies based on CPR or 17-OHCS determinations, and therefore are useful from the standpoints of diagnosis and therapy.

Exophthalmometric measurements were made in normal children, using a small,inexpensive, plastic Luedde ruler. The data are useful to pediatricians who wish to determine the degree of exophthalmos or enophthalmos and to follow progressive changes in eye measurements in their patients.

In a double-blind randomized study 150 outpatients receivng the same anesthetic for first trimester therapeutic abortions were equally divided into three groups: control; droperidol, 2.5 mg IM; or hydroxyzine, 100 mg IM. The injection was given immediately after thiamylal (Surital) induction of anesthesia, and the incidence of nausea, retching, or vomiting (NRV) was recorded at 15-minute intervals for 3 hours after surgery. NRV occurred in 56% of control patients, in 44% of patients given droperidol, and in 10% of patients given hydroxyzine. The patients receiving hydroxyzine and droperidol were more sedated and experienced a delay in return of hand-eye coordination as measured by the time for the Trieger motor test to reach preoperative levels. All patients equaled their preoperative performance during the 3rd hour after surgery and were discharged 4 hours following general anesthesia. We conclude that intramuscular hydroxyzine hydrochloride, 100 mg, is a significantly better antiemetic than intramuscular droperidol, 2.5 mg.

The elimination of succinylcholine appears to follow first-order kinetics with a linear relationship between intensity of effect and logarithm of the dose. Determination of the time-course of neuromuscular blockade following succinylcholine in infants and children allowed us to compare the rate of recovery and elimination rate constant with those determined by others in adults. The rate of recovery was independent of dose for each age group. The rate of recovery was faster in children than in infants; the rate of recovery of infants was faster than that of adults. The elimination rate constant for infants was similar to that of children; for both the infants and children the rate constants appeared dissimilar from those of adults.

We defined 218 children at high risk for otitis media (OM) in that each had received myringotomy with tympanostomy-tube placement (M & T) and, subsequent to tube extrusion, had developed recurrent acute or secretory OM. 102 children were assigned to an adenoidectomy or control group randomly, and 116 according to parental preference, and all were followed closely. Standardized antimicrobial regimens were used for new episodes of OM, as were specified criteria for repeat MST for persistent middle-ear effusion. Each ear of each subject on each follow-up day was categorized as with or without tube, and with or without OM. Preliminary results in the random trial in subjects largely completing full years of follow-up were as follows: In the nonrandom trial, results also tended to favor surgical subjects, but the differences were not statistically significant.

We determined, in monkeys, whether halothane-induced cerebrovascular dilation is mediated by beta-adrenergic receptors and whether cerebrovascular tone progressively returns to baseline values during prolonged halothane anesthesia. Total cerebral blood flow (CBF), cerebral perfusion pressure, plasma halothane concentration, and arterial blood gas tensions and pH were measured in 14 rhesus monkeys mechanically ventilated with 0.5% (inspired) halothane, 33% O2 and balance N2O. Halothane was increased to 2.0% and the measurements repeated 30 and 60 min later. Then either 0.9% NaCl (controls n = 6) or propranolol (n = 8), 1.0 mg/kg was infused intravenously over 10 min, and the measurements repeated at 70, 90, 120, and 150 min. After 30 min at 2.0% halothane, CBF increased in the controls by 50% (P less than 0.05) from 92 +/- 8 (mean +/- SD) to 137 +/- 39 ml X 100 g-1 X min-1 and in the propranolol group by 30% (P less than 0.05) from 106 +/- 33 to 137 +/- 28 ml X 100 g-1 X min-1. After 2.5 hr of 2.0% halothane anesthesia, CBF remained elevated above baseline levels, but by only 28 and 23% in the control and propranolol groups, respectively. Cerebrovascular resistance was identical in both groups (0.55 +/- 0.33 vs 0.53 +/- 0.13 mm Hg X ml-1 X 100 g 1 X min 1). The results show that there is only a 10-20% return of CBF toward baseline levels after up to 2.5 hr of 2% halothane anesthesia. The results also indicate that halothane-induced cerebrovascular dilation is not mediated by beta-adrenergic receptors.

Morphine (0.2 mg/kg) and diazepam (0.1 mg/kg) were injected IV after delivery of the fetus in 68 parturients undergoing cesarean section (CS). General anesthesia was with thiamylal-N2O-O2 (4:2) and muscle relaxant. Twenty-four to 36 hours postoperatively, 1 patient had recall, 1 had unpleasant dreams, and 2 had pleasant dreams. The incidence of recall and unpleasant dreams was 3.8 percent in elective CS and 0 percent in emergency cesareans. Morphine-diazepam combination caused anterograde and retrograde amnesia. During the cesarean, movement of patient, size of pupils, or changes in blood pressure were not indicative of awareness or dreams. During anesthesia, 33 percent O2 produced adequate oxygenation of mother and fetus.

Idiopathic (Bell's) facial palsy is a self-limiting, non-life threatening, and spontaneously remitting disorder. The natural history of Bell's palsy is favorable: 84% of 1011 patients with Bell's palsy studied by one investigator recovered satisfactorily without treatment, and no valid clinical trials conducted to date have provided definitive evidence that treatment with steroids or surgery improves upon this figure. The authors studied 273 patients with Bell's palsy to evaluate the prognostic significance of evoked electromyography in predicting the possible benefit of transmastoid facial nerve surgical decompression. The results indicated that even when evoked electromyography was used to select those patients who might benefit most from transmastoid surgery, outcome in patients treated surgically was no better than can be expected to occur without treatment. Based upon these observations, transmastoid facial nerve surgery is not recommended to treat Bell's palsy because no benefits have been identified which outweigh the risks of surgery.

For the treatment of early-onset neonatal hypocalcemia, 50 neonates received either a high dose (group H), a low dose (group L), or no parenteral calcium (Ca) (group CON). Groups H and L received parenteral Ca either as a continuous infusion (group C) or by intermittent injection (group I). After the first 24 hours of treatment, groups H, C, and I had higher serum Ca concentrations than did group CON. After the entire 72-hour study period, group H had a lower incidence of hypocalcemia (serum Ca level < 7.0 mg/dL) when compared with all other patients. Although a relatively high Ca intake statistically increased serum Ca levels, eight of 13 patients in group CON (62%) completed the 72-hour study without requiring parenteral Ca. Based on these results, we recommend parenteral Ca treatment for only those patients with persistent hypocalcemia, tetany, or a seizure disorder.

The effects of hormone and hormone-sera combinations on 3HT uptake by osteosarcoma tumor cells were evaluated. Multiple studies consistently showed a five-fold enhancement of 3HT uptake by serum from an osteosarcoma patient, compared to control inactivated serum, and 2x enhancement compared to normal human serum. Thymidine uptake factor corresponds to somatomedin. As somatomedin regulates bone and cartilage growth, 17B Estradiol, a known inhibitor of somatomedin, was tested in physiologic ranges: 80 pg/ml and 200 pg/ml. Inhibition of SHT uptake was 14% and 22%, respectively. These data support our ongoing and previous clinical and biochemical evidence that osteosarcoma patients may have elevated somatomedin; i.e. high tumor incidence at adolescence when somatomedin is highest, abnormal glucose tolerance and insulin levels. Estrogen therapy could be beneficial in management of this disorder.