BEHAVIORAL CHARACTERISTICS OF DANGEROUS DRIVERS—Importance of Correction

Studies of accident-prone drivers emphasize the frequency of unstable, aggressive or antisocial personalities expressing themselves through the automobile as a real and a symbolic weapon. Such expressions may be voluntary or unconscious and may also lead a driver to injure himself or seek injury from others.Because of the great public danger from such drivers, it is urgent that judges and enforcers of the law recognize the psychic motivation in habitual violation and withhold driving privileges from violators until a psychic adjustment has been made. Physicians can contribute in gaining acceptance for this attitude of enforcement, and in setting up adequate psychiatric procedures for correction of violators.     

Mechanism of Photosignaling by Drosophila Cryptochrome: ROLE OF THE REDOX STATUS OF THE FLAVIN CHROMOPHORE*?

Cryptochrome (CRY) is the primary circadian photoreceptor in Drosophila. Upon light absorption, dCRY undergoes a conformational change that enables it to bind to Timeless (dTIM), as well as to two different E3 ligases that ubiquitylate dTIM and dCRY, respectively, resulting in their proteolysis and resetting the phase of the circadian rhythm. Purified dCRY contains oxidized flavin (FAD_ox), which is readily photoreduced to the anionic semiquinone through a set of 3 highly conserved Trp residues (Trp triad). The crystal structure of dCRY has revealed a fourth Trp (Trp-536) as a potential electron donor. Previously, we reported that the Trp triad played no role in photoinduced proteolysis of dCRY in Drosophila cells. Here we investigated the role of the Trp triad and Trp-536, and the redox status of the flavin on light-induced proteolysis of both dCRY and dTIM and resetting of the clock. We found that both oxidized (FAD_ox) and reduced (FAD^⨪) forms of dCRY undergo light-induced conformational change in vitro that enable dCRY to bind JET and that Trp triad and Trp-536 mutations that block known or presumed intraprotein electron transfer reactions do not affect dCRY phototransduction under bright or dim light in vivo as measured by light-induced proteolysis of dCRY and dTIM in Drosophila S2R+ cells. We conclude that both oxidized and reduced forms of dCRY are capable of photosignaling.     

TREATMENT OF SUPERFICIAL FUNGOUS INFECTIONS—Value and Limitations of Systemic Administration of Griseofulvin

Comprehensive studies and numerous clinical reports have shown that griseofulvin orally in a dose of 1 gm. daily is an effective treatment for superficial fungous infections of the skin, hair and nails. The drug is not effective against yeast infections (moniliasis), bacterial infections or most of the deep fungous infections.Duration of treatment varies with the site of infection, glabrous skin, crotch and scalp responding within four to five weeks. Infections of palms, soles and nails require a considerably longer time, palms healing more quickly than soles and fingernails more quickly than toenails, which may require up to a year of continuous treatment.Auxiliary measures such as clipping hair, removing infected nail tissue and topical fungicides shorten the duration of treatment.No serious side effects have been reported. Minor discomforts such as headaches and mild rashes occur in some cases.Observations of a series of 49 patients with superficial fungous infections, especially hand, foot and nail infections due to Trichophyton rubrum, confirmed these reports taken from the literature. Attempts to use a reduced dosage schedule did not prove satisfactory.     

FRACTURE OF THE METACARPAL SHAFT—A Method of Treatment

Anatomically, metacarpal fractures, when reduced, are not spontaneously stable. They require maintenance of this reduction because of the forces acting on the fragments. Closed methods of maintaining this reduction are ideal, but in selected cases, intramedullary fixation of the fracture, using the Kirschner wire, gives excellent results. The method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced “blind.” Correct placement of the site of insertion of the wire, coupled with the rigid immobilization thus attained, gives excellent results in a high proportion of selected cases.     

PRIMARY CARCINOMA OF THE GALLBLADDER—Review of 173 Cases

One hundred seventy-three cases of primary carcinoma of the gallbladder were analyzed. In the group studied they made 2.11 per cent of all malignant tumors found at autopsy and were found in 1.89 per cent of all cases in which operation was done on the biliary tract. There was no appreciable change in the incidence of this tumor at autopsy during the period studied (1918-1948) at the Los Angeles County Hospital. Sixty-eight per cent of the cases were in females. A particularly high incidence was noted in Mexican females.Upper abdominal pain, loss of weight, nausea and vomiting, jaundice, and palpable mass or enlarged liver were the most common clinical features. Approximately one-third of the patients in whom the lesion was found at operation and one-fifth of all the patients whose records were studied had a history of chronic gallbladder disease.All but two of the 38 patients operated on were dead or had clinical recurrence within two years. One was alive and well 12 years after cholecystectomy.The most common gross appearance, particularly at autopsy, was a large tumor mass replacing the gallbladder and radiating to nearby organs, particularly the liver. In about one-third of the cases the tumor was grossly limited to the gallbladder. Polypoid tumors occurred in only about 10 per cent of the cases and most of the tumors were diffusely growing adenocarcinoma. Perforation appeared in nine cases, usually with fistula to the gastrointestinal tract. All of the tumors were histologically adenocarcinoma, usually of simple glandular structure. No purely squamous cell growth occurred.Gallstones were found in 79.8 per cent of the cases.     

Best Wishes for the Launch of THE JOURNAL OF FUNGAL RESEARCH

IoffermysinceregoodwishestotheorganizersofTHEJOURNALOFFUNGALRESEARCHforitslaunchandforitscontinuedscientificandfinancialsuccess.Thiswill,ofcourse,dependverylargelyontheabilityoftheeditorstoattractfirstclassarticles,reviewsetc.,writtenbyresearchworkerswhoarepreparedtocommittheirpublicationsandreputationstoajournalwhoseimpactfactorcannot,asyet,bemea sured .ItwillalsodependonachievingawidecirculationnotonlyinsideChinabuttoaninternationalreadership ,inthefaceofstiffcompetitionfromestabli…     

MANAGEMENT OF JUVENILE RHEUMATOID ARTHRITIS—The Problem of Long-Term Rehabilitation

A program for the management of juvenile rheumatoid arthritis should permit the child an optimal developmental experience despite the persistence of potentially crippling inflammatory disease. Drugs are useful, although no more than palliative, and all are significantly toxic. Physical measures should be directed toward the improvement of joint alignment and mobility and the restoration of muscular strength. The emotional, social and educational needs of a child with such a chronic disability deserve the most thoughtful attention.     

MODERN TREATMENT OF PLACENTA PREVIA—A Study of 234 Cases

Study was made of 234 cases of placenta previa occurring in 48,752 deliveries at one hospital during the period 1947-1956. There was no maternal mortality. The uncorrected fetal mortality rate for all weight groups was 21.4 per cent. The rate varied from 88 per cent in babies under 1,500 grams to 5.7 per cent in babies over 2,500 grams. Initial conservative management to permit gestation to continue as close to term as possible is advisable.Ultimate termination of the pregnancy by cesarean section under spinal anesthesia gave the best results. The incidence of transverse and breech presentations in association with placenta previa was inordinately high. A progressive trend toward more conservative treatment of placenta previa was noted in the present series, with a concomitant reduction in fetal mortality rate.     

CONGENITAL DISLOCATION OF THE HIP—A Study of Open Reduction After Failure of Conservative Treatment

In a study of 42 cases in which open reduction of congenital dislocation of the hip was carried out after conservative treatment had failed, the following observations were made (in a relatively short period of follow-up observation):No one pathological change, as observed at operation, was inordinately associated with failure of closed reduction.By far the highest incidence of successful results of open reduction was obtained in cases in which the operation was done in the second and third year of life.The highest incidence of successful operation, as appraised immediately after the procedure, was in patients more than one year and less than six years of age.Results as determined roentgenographically were in close agreement with results observed clinically.     

THE MANAGEMENT OF ALLERGIC PATIENTS—The Role of the Internist

There has been an increasing trend in the United States toward intensive specialization in allergic diseases. Whereas the tendency toward specialization has led to greater knowledge of the scientific aspects of allergic phenomena, it has somewhat diverted the specialists'' attention from the many clinical problems that await solution.Effective treatment of the allergic patient depends in no small measure on the broad viewpoint and clinical experience of the internist. This fact has been reemphasized by the growing awareness of the significance of the secondary or precipitating causes, such as climatic, nutritional, hormonal and psychogenic factors which influence allergic manifestations. Overemphasis on specialization in allergic diseases with their wide ramifications may defeat the main objective—a successful therapeutic result.To meet this challenge, the internist should be trained in allergy and yet retain a broad approach to the more basic problems of internal medicine. This objective may be attained by certain modifications in undergraduate medical instruction in allergy. Postgraduate training sponsored by our national allergy societies affords internists an excellent opportunity to advance their knowledge of clinical allergy.     

A REPORT OF BIRDS OF NORTHEASTERN YUNNAN

A zoological expedition was made from March to June, 1975, in Northeastern Yunnan at Southeast of Yangtze River (27°30′—28°40′ N., 103°15′—104°25′E.). 450 specimens of birds were collected. Orders and families treated in this paper are listed below:     

TREATMENT OF ENDOTOXIC SHOCK—The Dilemma of Vasopressor and Vasodilator Therapy

Hemodynamic studies have demonstrated that the fall of blood pressure in shock caused by endotoxin in dogs does not result primarily from dilatation or “vasomotor collapse.” Indeed, vasoconstriction is increased and may be excessive. Progression of shock has recently been blamed on such excessive vasoconstriction. For this reason the use of sympathomimetic drugs as vasopressor agents has been challenged and sympatholytic or adrenolytic agents have been recommended.In the present study, vasopressor and vasodilator drugs were used for the treatment of shock in dogs caused by endotoxin. Vasodilator drugs, when used after the onset of shock, hastened a fatal outcome but vasopressor agents were not detrimental when used in moderate doses.The effectiveness of the vasopressor agent is not necessarily due to a primary vasoconstrictor action on arteries and arterioles, as previously assumed.     

SEQUELAE OF ENCEPHALITIS—Report of a Study After the California Epidemic

In a study of almost 500 patients to determine residual effects, the sequelae of both St. Louis and Western equine encephalitis were more prominent in the younger age group. Infants under three months with Western equine encephalitis had the greatest central nervous system damage. Forty-four per cent of this entire group had sequelae.In patients between one and four years of age, the incidence of sequelae was less. The Western equine infection was associated with the more disabling residual damage. Postencephalitic convulsions were fairly common in the younger patients with Western equine disease, but not in the St. Louis group. After the age of five the sequelae rate dropped. In all age groups the Western equine residual changes were more severe than the damage of St. Louis infection.Some infants, children and adults showed remarkable improvement from sequelae even as much as two years after the abnormalities occurred.With the longer period of follow-up, some late sequelae were noted in children and adults, primarily among those who had Western equine infection.     

THE REPAIR OF DIFFICULT INGUINAL HERNIAS—Resection of the Spermatic Cord

A method of removing the cord structures from the inguinal canal and preserving the testis and the portion of the spermatic cord distal to the external ring was used in repair of large or recurrent hernias in 14 patients. Only one patient had pronounced testicular atrophy. In one case there was recurrence through the femoral canal. The procedure is simpler and shorter than removal of the testicle as well as the cord.     

TEMPERATURE COEFFICIENT OF THE ACTION OF β-RAYS UPON THE EGG OF NEREIS

The temperature coefficient of the action of β-rays from radium upon the egg of Nereis lies between 1.1 and 1.2. This is of a magnitude characteristic of photochemical reactions.     

MODERN MANAGEMENT OF TUBERCULOSIS—The Public Health Implications of Recent Advances

Modern treatment for tuberculosis has greatly increased the problem of preventing spread of infection. BCG vaccination, for instance, would cause all persons to react to tuberculin test so that the possibility of tuberculosis could never be ruled out by this means. Streptomycin and more recently developed drugs may sterilize sputum so that diagnosis cannot be confirmed for some time after use of such drugs; when by use of these drugs the disease had been confined to caseous encapsulations, later breakdown of the encapsulations may release strains of bacilli resistant to the drugs both in the patient and in others infected with them. The temporary sterilization of sputum, coupled with the euphoria resulting in part from abrupt remission of the toxic state, may lead to premature discharge of patients from sanatoria and further spread of tuberculosis. Both the public and the profession must be impressed with these facts.For more profitable than minifilm surveys of normal populations are routine x-ray examination of all patients admitted to hospitals (by which two to five times as many cases have been found) and follow-up of persons who have had contact with tuberculosis patients (thirteen times as many cases found).A study being conducted by the California Tuberculosis and Health Association indicates that in many counties neither the number of x-rays made in public surveys nor the number of cases found is known or even to be estimated from existing records.Because of reduction in deaths due to tuberculosis some public officials are reluctant to spend for further treatment facilities. As the actual number of cases is increasing in many areas, however, expenditures will have to be increased.     

INJURIES OF THE HAND AND FOREARM—Treatment of Damaged Soft Tissues

Successful primary repair of soft tissue injuries of the hand and forearm holds the ultimate disability to a minimum. The kinds of trauma and the resultant soft tissue damage may be classified. Attention to details and technique in carrying out the primary reparative operation on the injured hand largely obviates a crippling deformity or the need for much reconstruction later.     

ON NEW MATERIAL OF STEGODON WITH RECOLLECTIONS OF THE CLASSIFICATION OF STEGODON IN CHINA

ReviseddiagnoaisCraniumcompressedanteroposteriorlyandhighvertical1y.Superiortuskslargeandstraight,nolowerincisors'Ridge-platesprogressiveIymulti-plyingfromsixtoelevenintheintermediateteeth,fromninetofifteenandhaIfilltheposteriormolars.Thereisamediancleftoritsvestigesintheanteriorridge-platesoftheprimitivespecies.Conesrapidlysubdividingbybinaryorternary.fissionintomultipleconelets(8-l2).Ridge-plateselevatingfrombrachyodonttosubhypsodont.Cementdevelopingintheval1eys.RemarksSarwar(l977)propose…