What is new in adoption

Adoptions arranged through adoption agencies are on the increase because there are more agencies. The Citizens Committee on Adoption of Children in California has concluded that there are very few adoptable children under care in orphanages. Fifty per cent of physicians would prefer agency adoptions, but only 24 per cent actually refer both expectant mothers needing such services and couples wishing to adopt infants to such agencies. The program in this field of social welfare should be child-centered and physicians should seek and give cooperation to such agencies.     

WHAT PSYCHIATRISTS THINK ABOUT ALCOHOLISM

The one approach most favored for alcoholism by psychiatrists in Southern California who answered a questionnaire is membership in Alcoholics Anonymous. Ninety-nine per cent of them approved Alcoholics Anonymous, and 80 per cent had referred patients to the organization. Yet they believed only 10 per cent of the persons who join A.A. remain sober for over two years. This against the claim of A.A. that 60 per cent or more of their fellowship are recovered emphasized the pessimism of the psychiatrists questioned.Ninety per cent of the psychiatrists who replied said they do not treat alcoholics or that they limit the number or the type they will accept for treatment. They obtain recovery, they said, of 10 per cent of patients, improvement of 50 per cent, and the rest are unchanged.The emphasis in psychiatry is on elimination of the anxieties leading to alcoholism; in Alcoholics Anonymous the emphasis is on the strength to bear these anxieties. Ninety per cent of the replies received were in favor of clinics for alcoholics, and the respondents felt that governmental agencies should support these clinics. Under such circumstances psychiatrists would combine their abilities with psychologists, social workers and Alcoholics Anonymous. Thirty-five per cent of psychiatrists said they are willing to work in a clinic, the majority without recompense.     

Results of irradiation in cancer of the lip,tongue and ear

CANCER OF THE LIP: The primary lesion can be controlled by irradiation in approximately 80 per cent of cases. For lesions with metastases there is only about a 25 per cent chance of five-year arrest (irradiation of the primary lesion followed by excision of involved nodes). CANCER OF THE TONGUE: Lesions in the anterior two-thirds are controllable by irradiation in about 50 per cent of cases if the nodes are not involved; the salvage is only about 15 per cent if the nodes are involved (nodes treated surgically). Lesions in the posterior third of the tongue are seldom controlled in the author's experience. CANCER OF THE EAR (AURICLE): Five-year arrest of basal-cell lesions should be attained by irradiation in about 80 per cent of cases; of squamous-cell lesions in about 60 per cent. If the lesion is extensive, radiation does not offer a superior cosmetic result to operation and entails danger of late chondronecrosis. Therefore extensive lesions are probably best treated surgically. In either event, it appears probable that results of irradiation can be improved by the use of more adequate fields and greater fractionation.     

RESULTS OF IRRADIATION IN CANCER OF THE LIP,TONGUE AND EAR

Cancer of the lip: The primary lesion can be controlled by irradiation in approximately 80 per cent of cases. For lesions with metastases there is only about a 25 per cent chance of five-year arrest (irradiation of the primary lesion followed by excision of involved nodes).Cancer of the tongue: Lesions in the anterior two-thirds are controllable by irradiation in about 50 per cent of cases if the nodes are not involved; the salvage is only about 15 per cent if the nodes are involved (nodes treated surgically). Lesions in the posterior third of the tongue are seldom controlled in the author''s experience.Cancer of the ear (auricle): Five-year arrest of basal-cell lesions should be attained by irradiation in about 80 per cent of cases; of squamous-cell lesions in about 60 per cent. If the lesion is extensive, radiation does not offer a superior cosmetic result to operation and entails danger of late chondronecrosis. Therefore extensive lesions are probably best treated surgically. In either event, it appears probable that results of irradiation can be improved by the use of more adequate fields and greater fractionation.     

The California tumor registry

The California Tumor Registry, in which 71,215 cases have been entered, provides data for professional and public education which is specific to the state. It has suggested leads for epidemiological investigation of cancer. Participating agencies are assisted in maintaining adequate follow-up systems through annual listing of cases by the State Department of Public Health and removal from the list of cases in which death occurs. Among the first cases analyzed, the diagnosis was confirmed microscopically in 70.6 per cent. Only 36.2 per cent of patients had visited a physician within two months after onset of symptoms. Survival of patients with cancer is compared with their expectancy calculated from life-tables, thus taking account of deaths from causes other than cancer.     

THE CALIFORNIA TUMOR REGISTRY

The California Tumor Registry, in which 71,215 cases have been entered, provides data for professional and public education which is specific to the state. It has suggested leads for epidemiological investigation of cancer. Participating agencies are assisted in maintaining adequate follow-up systems through annual listing of cases by the State Department of Public Health and removal from the list of cases in which death occurs. Among the first cases analyzed, the diagnosis was confirmed microscopically in 70.6 per cent. Only 36.2 per cent of patients had visited a physician within two months after onset of symptoms. Survival of patients with cancer is compared with their expectancy calculated from life-tables, thus taking account of deaths from causes other than cancer.     

The antibiotic prophylaxis of postoperative complications in breast cancer patients

The studies showed that infectious complications in patients operated for breast cancer (BC) most frequently developed after removal of the drainage tube resulting in poorer discharge favourable for development of infections. The causative agents in such cases are usually exogenous bacteria differing from endogenous ones (Staphylococcus epidermidis) inhabiting the human skin and sometimes contaminating the operative field. The endogenous bacteria are detectable bacteriologically in 60 per cent of the cases. Still, since the operation wound contains humoral and tissue immunity factors (specifically active against the host microflora) such bacteria rarely grow on artificial media (18 per cent) and even more rarely cause infections. Therefore, to prevent postoperative infections in patients with BC it should be recognized rational to use broad-spectrum antibacterial drugs such as ampiox, ampicillin, doxycycline, cephalosporins of the 2nd and 3rd generations, etc. for 5 to 6 days after the drainage removal. If an infection develops the preventive therapy should be replaced by an adequate therapy in accordance with the pathogen sensitivity.     

Prevention of suicide

Suicide is the ninth major cause of death in the nation. California, according to the latest comprehensive figures (1949), ranks about 50 per cent above the national average. Yet the importance of suicide as a cause of death is gravely underestimated. At hospitals and other agencies only emergency treatment is given before discharge of persons who attempt suicide, although it is known that many will repeat the attempt. Rarely is psychiatric evaluation carried out or definitive treatment prescribed. Suicidal symptoms are often ignored in other cases. Physicians have a responsibility, as in any disorder, to recognize signs and symptoms of impending suicide and to use all means of prevention. Prevention could be forwarded by the education of physicians and laymen in detecting early signs of depression, in recognizing accident proneness, and in insisting upon legal control of use of barbiturates, a common means of suicide. Lay associations should encourage individuals with suicidal impulses to go to psychiatric clinics for help. Police should learn how to deal with suicidal attempts, and hospitals should include psychiatric examination and advice as to treatment of all such persons. Suicidal attempts should be registered and reported to public health officers in the same way as are other dangerous diseases. More research should be done on case records of these patients, in order to better understand motivations and means of prevention.     

COMPARATIVE STUDIES ON RESPIRATION : V. THE EFFECT OF ETHER ON THE PRODUCTION OF CARBON DIOXIDE BY ANIMALS.

1. The experiments on frog tadpoles show that with 0.15, 0.37, and 0.55 per cent ether solutions there is a decrease in CO₂ output. The effect is reversible. With these concentrations the breathing movements and body movements remained normal during the experiment. In 3.65 and 7.3 per cent ether there is a decrease of respiration followed by an increase which in turn is followed by a decrease. The increase may reach about three times the normal rate. The increase in the CO₂ output is accompanied by the peeling of the skin. The effect is irreversible. 2. Experiments on an aquatic insect, Dineutes assimilis Aube, show that in 7.3 per cent ether there is a decrease followed by an increase which in turn is followed by a decrease. There is no apparent disintegration of structures in the organism accompanying the increase. The effect is irreversible. 3. The experiments on frog eggs with 7.3 per cent ether show a result similar to that found in aquatic insects. 4. Experiments on Fundulus embryos show that with 0.73 per cent ether there is a reversible decrease in the rate of CO₂ production. In 3.65 per cent ether there is a temporary decrease followed by an increase, after which the rate begins to fall off. In 7.3 per cent ether there is an immediate increase amounting to 307 per cent which is followed by a decrease. The increase in the 3.65 and 7.3 per cent ether is accompanied by irreversible changes leading to death. The decrease found in 0.73 per cent ether is not sufficient to cause narcosis, as is shown by experiments on which the same decrease is produced by lowering the temperature. 5. These experiments show that narcosis is not due to asphyxia. The action of anesthetics is due to some other cause than the effect on respiration. There is a difference between the animals studied and the plants described in this series of articles, since in animals the increase in the CO₂ output is accompanied by irreversible changes leading to death, while this is not necessarily the case in plants. The reversible (narcotic) action of ether on the animals studied was accompanied by a decrease in the carbon dioxide output; in plants this is not ordinarily the case. These facts are of considerable interest, but their interpretation must be left to future investigation.     

CESAREAN SECTION EXPERIENCE AT THE UNIVERSITY OF CALIFORNIA HOSPITAL

A review of the 746 cesarean sections performed at the University of California Hospital from 1907 through 1948 shows an overall cesarean section incidence of 3.91 per cent. The maternal mortality rate associated with these cesarean sections has been 1.61 per cent. There has been a steady decline in mortality over the 40-year period and there have been no deaths from cesarean section in the last ten years. The over-all incidence of morbidity associated with cesarean section has been 40.5 per cent and again there has been a significant improvement in recent years. The fetal mortality associated with cesarean section has been 6.1 per cent. In view of recent experience, standards based on figures collected 20 years ago are no longer tenable.     

Chromatin phospholipid changes during rat liver development

The chromatin extracted from rat hepatocytes of different ages has been shown to contain a phospholipid fraction representing 0.47-0.59 per cent of total chromatin in newborn animals and 0.22 per cent in 45-day-old animals. No such age-related differences are observed in the nuclei. The phospholipid composition of the nuclei at different ages shows a higher level of sphingomyelin and a lower level of phosphatidylserine in newborn than in adult animals. Chromatin phospholipids have a completely different composition from that of nuclei with respect to age, particularly in newborn rats, where there is a decrease in phosphatidylcholine and an increase in phosphatidylserine.     

Surgical Treatment of Mitral Insufficiency

Sixty-four patients with pure mitral insufficiency were operated upon. Thirty of them had torn chordae tendineae. It was possible to repair the mitral valve in 57 patients and there were five operative deaths. One patient had a femoral artery embolus and another had a cerebral embolus. The incidence of peripheral embolization was 4 per cent compared with 40 per cent reported for ball valve replacement.Forty-eight of the 57 patients with repair (84 per cent) were living and well with at most a grade II/VI apical systolic murmur up to seven and a half years after operation. There has been no evidence of recurrence in these patients.In approximately 90 per cent of patients with pure mitral insufficiency, repair should be performed. When feasible, repair is more satisfactory than valvular replacement, with not only excellent long-term results, but far less morbidity than is reported with ball valve replacement.     

Directed isolation of Micromonospora generic cultures from moist soils and silts

The data on the study of various soils and substrates for isolation of Micromonospora from them are presented. It was shown that Micromonospora predominated in moist soils and especially in such substrates as silts where their content with respect to the all actinomycetous isolates amounted to 88.9 per cent. In the silts the content of Micromonospora amounted to 66.6--83 per cent, in the sopromely its content was 66 per cent, while in the ordinary non-moist soil its content was from 6 to 11 per cent. Predominance of Micromonospora in silts and moist soils makes its directed search possible.     

Attitudes toward specific therapies

Attitudes of the physician and attitudes of the patient may affect the rational use of specific therapies. An example is the use of penicillin for the common cold. A survey showed that 25 per cent of physicians and 16 per cent to 22 per cent of three other groups polled had received penicillin for a cold, although there is no rational basis for such therapy. Evaluation of both the physicians' and patients' attitudes toward specific therapies might lead to a more rational treatment of the patient as a total personality.     

Autopsy in California

From information complied from death certificates registered in 1952 and 1962 an examination was made of California''s autopsy performance and the characteristics of deaths in which autopsy was done. The data indicated that California had an overall autopsy rate of 37 per cent of total deaths in 1962, probably higher than any other state. In the decade reviewed, there was a 62 per cent absolute increase in autopsies and a 7 per cent increase relative to total deaths.Substantial increases in the proportion of deaths in which autopsy was done were found for physician-certified deaths in both metropolitan and nonmetropolitan counties and for coroner-certified deaths in nonmetropolitan counties. For all but two of forty-five selected natural causes of death there were increases in the proportion of deaths in which autopsy was done.Seventy per cent of deaths occurred in some type of facility. About one-half of all deaths occurred in general hospitals, and autopsy was done in 42 per cent of such cases.The dual factors of a high autopsy rate and overrepresentation of deaths brought to autopsy in white males, ages 35-64, support the validity of a reported decline in California''s death rate for arteriosclerotic heart disease.     

Effect of varying static and changing moisture levels during incubation on extractability of soil phosphate

Summary A sandy loam (pH 6.5) was incubated at 28°C at static moisture levels, ranging from 10 per cent saturation to 133 per cent saturation (waterlogging), for 6 and 12 weeks; other samples covering the same moisture range were first incubated for 6 weeks, and after changing all moisture levels to 50 per cent saturation were incubated for a further 6 weeks.With increasing static soil moisture level during incubation there was a slight reduction in Morgan-extractable phosphate up to 70 per cent saturation, but thereafter, due to anaerobic effects, there were considerable increases in extractable phosphate with increasing moisture level.With changing moisture level during incubation the effects of anaerobiosis became apparent where original moisture level was greater than 50 per cent saturation; extractable phosphate was reduced to levels lower than those occurring where the soil was maintained continuously at 50 per cent saturation. The extent of reduction in extractable phosphate increased with original soil saturation level.     

Purulent complications in the surgical treatment of patients with mouth cancer and their prevention]

Local purulent complications after surgical operations for mouth cancer were recorded in 49 (61.3 per cent) out of 80 cases and were mainly due to associations of 2 or more pathogens. The analysis of the factors influencing the development of the complications showed that there was no reliable increase in the number of the complications in the patients subjected at the first stage to the treatment with various antitumor agents: 17 (53.1 per cent) events in the group of the patients subjected to radiotherapy in a total focal dose of 40 Gy, 8 (72.7 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy, 13 (59.1 per cent) events in the group of the patients treated with antitumor drugs and 8 (66.7 per cent) events in the group of the patients operated at the first stage of the treatment. The incidence of osteomyelitis was significantly higher in the group of the patients subjected to radiotherapy before the operation: 13 (30.2 per cent) events vs. 2 (5.4 per cent) in the group of the patients not subjected to radiotherapy. With increasing of the radiation dose, the incidence of osteomyelitis as well increased: 8 (25.0 per cent) osteomyelitis events in the group of the patients subjected to radiotherapy in a dose of 40 Gy and 5 (45.5 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy. The method of osteosynthesis of the lower maxilla with titanium miniplates was also of great importance. The use of various schemes for antibiotic prophylaxis of wound infection in such patients was equally efficient.     

THE PREARGININE IN EDESTIN AND ITS RESISTANCE TO HYDROLYSIS

The titration data of edestin show that all the arginine found on hydrolysis exists in this protein as "prearginine." The extra ionizable groups of histidine, lysine and tyrosine are free in the quantities found on hydrolysis. Part of the extra carboxyl groups of aspartic and glutamic acids are bound as amides, and 50 per cent are bound in some other manner (perhaps anhydride) leaving only about 6 per cent of these groups free to ionize in edestin. The prearginine in edestin is not converted into arginine on hydrolysis with pepsin up to 18 per cent (of the total hydrolysis). In more highly hydrolyzed solutions it is not possible to detect such a conversion, due to high buffering. Complete hydrolysis however converts prearginine into arginine which can be isolated. Hydrolyzed edestin promotes the growth of sarcomatous fibroblasts about equally well whether 5, 14 or 18 per cent hydrolyzed.     

ULTRASTRUCTURE OF THE RESTING AND CONTRACTED STRIATED MUSCLE FIBER AT DIFFERENT DEGREES OF STRETCH

Passive stretch, isometric contraction, and shortening were studied in electron micrographs of striated, non-glycerinated frog muscle fibers. The artifacts due to the different steps of preparation were evaluated by comparing sarcomere length and fiber diameter before, during, and after fixation and after sectioning. Tension and length were recorded in the resting and contracted fiber before and during fixation. The I filaments could be traced to enter the A band between the A filaments on both sides of the I band, creating a zone of overlap which decreased linearly with stretch and increased with shortening. This is consistent with a sliding filament model. The decrease in the length of the A and I filaments during isometric contraction and the finding that fibers stretched to a sarcomere length of 3.7 µ still developed 30 per cent of the maximum tetanic tension could not be explained in terms of the sliding filament model. Shortening of the sarcomeres near the myotendinous junctions which still have overlap could account for only one-sixth of this tension, indicating that even those sarcomeres stretched to such a degree that there is a gap between A and I filaments are activated during isometric contraction (increase in stiffness). Shortening, too, was associated with changes in filament length. The diameter of A filaments remained unaltered with stretch and with isometric contraction. Shortening of 50 per cent was associated with a 13 per cent increase in A filament diameter. The area occupied by the fibrils and by the interfibrillar space increased with shortening, indicating a 20 per cent reduction in the volume of the fibrils when shortening amounted to 40 per cent.     

Gene frequency in an artificial colony of the Scarlet Tiger Moth Panaxia dominula (L.) after 28 years

An artificial colony of Panaxia dominula was started in Wirral in 1961 by P. M. Sheppard to study the selection acting on the medionigra gene. Previous evidence from Oxford indicated a lowered fitness which, balanced by a mating advantage, led to an equilibrium at about three per cent. The Wirral colony was rediscovered in 1989 and now has a medionigra gene frequency of 27 per cent compared with an initial one of 25 per cent, i.e. the Hardy-Weinberg equilibrium has been virtually unchanged. The selective balance in the colony is therefore very different from that elsewhere, and the suggestion is made that the original gene frequencies have remained unchanged because there has been no human interference, unlike Oxford where mark-release-recapture has been the standard procedure, but there are some caveats to this view.