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Malnutrition and sarcopenia are associated with increased morbidity and mortality in cirrhosis but conflicting data are reported after liver transplantation (LT), with little known about the economic burden of malnutrition at LT. This study aims to investigate the impact of pre-transplant malnutrition and muscle strength on post-transplant clinical outcomes and healthcare costs.Pre-transplant nutritional status (via subjective global assessment, SGA) and handgrip strength (HGS) were assessed in patients transplanted from 2009-2017. Descriptive statistics and regression analysis were used to analyse the association between nutrition and muscle function with post-LT clinical outcomes and hospital costs.373 patients (70% male, median age 55 [IQR: 47, 60]) were transplanted, with 79% malnourished and mean HGS 31.4 ± 9.35 kg for males and 17.6 ± 5.78 kg for females. Malnutrition and reduced HGS independently predicted adverse post-transplant outcomes. ICU length of stay (LOS) was associated with severe malnutrition (HR (time to discharge (TTD)) 0.706, p = 0.014) and low HGS (HR (TTD) 0.692, p = 0.003); hospital LOS with severe malnutrition (HR (TTD) 0.759, p = 0.049) and low HGS (HR (TTD) 0.730, p = 0.011), and post-transplant infection with severe malnutrition (OR 1.76, p = 0.042) and low HGS (OR 1.83, p = 0.015). Accordingly, hospital costs were 30% higher in severely malnourished compared to well-nourished recipients (p = 0.012). Neither malnutrition or impaired HGS were associated with post-transplant mortality.This large cohort study demonstrates malnutrition and muscle weakness are independently associated with early post-transplant morbidity, namely infection and ICU and hospital LOS; with significantly increased hospital costs. Strategies to combat malnutrition and deconditioning pre-transplant may improve patient and health system outcomes after LT.

Acute kidney injury after cardiac surgery (AKICS) is common. Previous studies examining the role that mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) may have on AKICS have not taken into account how baseline central venous pressure (CVP) and mean perfusion pressure (MPP) (i.e. MAP − CVP) can influence its evolution. To assess whether the change in MPP to the kidneys (i.e. delta MPP or DMPP) during CPB compared to baseline is an independent predictor of AKICS. After ethical approval, a retrospective observational study was performed on all patients undergoing CPB between October 2013 and June 2015 at a university-affiliated hospital. Known risk factors for the development of AKICS were recorded, as were the MPP values at baseline and during CPB. From this, statistical modelling was performed to identify predictors of postoperative AKICS. 664 patients were identified. Analysis was performed on 513 patients after exclusion. On logistic regression, significant and independent predictors of AKICS included: d20DMPP (cumulative duration of MPP values during CPB that were 20% below baseline and exceeded three consecutive minutes) (P = 0.010); baseline CVP; age; pre-operative creatinine level; and left ventricular (LV) dysfunction (ejection fraction (EF) P = 0.003). Modelling without taking into account CVP also supported this association. The duration of differences in perfusion pressure to the kidneys during CPB compared to baseline is an independent predictor of AKICS.

INTRODUCTION Oral bisphosphonates are first-line agents for treating osteoporosis in men, but there are no studies regarding efficacy of oral bisphosphonates for treatment of osteoporosis in ambulatory male adults with intellectual disability. METHODS Nine adult males with intellectual disability and increased fracture risk had been treated with weekly or monthly oral bisphosphonates, vitamin D and calcium for 1-3 years. Post-treatment bone mineral density (BMD), serum 25(OH)D, parathyroid hormone and C-telopeptide of type I collagen were then determined for the first time. RESULTS Weekly or monthly oral bisphosphonates were well tolerated and led to significant increases in BMD in all 9 individuals. Serum 25(OH)D level enhanced the "pecent increase of BMD" that occurred in response to bisphosphonate treatment (p

BACKGROUND AND AIMS Endoscopic variceal band ligation (EVBL) aims to eradicate high-risk oesophageal varices. There is a small risk of precipitating bleeding from EVBL-induced oesophageal ulceration, which is associated with significant mortality. We explore the risk factors and outcome of EVBL-induced ulcer bleeding. METHODS Retrospective review of our endoscopy database between 2007 and 2012 identified upper endoscopies during which EVBL was performed. Patient demographics, biochemistry and endoscopic findings were recorded as were the complications of EVBL-induced ulcer bleeding and death. RESULTS A total of 749 episodes of EVBL were performed in 347 patients with a mean Model for End-stage Liver Disease (MELD) score of 15.8. In all, 609 procedures were performed for prophylaxis and 140 for acute haemorrhage. There were 21 episodes (2.8% of procedures) of EVBL-induced ulcer bleeding in 18 patients, five of whom subsequently died (28%). On multivariable analysis, acute variceal haemorrhage was the only significant predictor of EVBL-induced ulcer bleeding [odds ratio (OR) 6.25 (2.57-15.14), P

Background Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon. Objective To assess whether retroflexion in the right side of the colon significantly improves the adenoma detection rate (ADR) over forward-view assessment. Design Multicenter prospective cohort study. Setting Three tertiary care public and 2 private hospitals. Patients A total of 1351 consecutive adult patients undergoing elective colonoscopy. Intervention Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure. Main Outcome Measurements ADR in the retroflexed view when compared with forward-view examination of the right side of the colon. Results Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Retroflexion identified a further 84 polyps of which 75 were adenomas, improving the polyp and ADR to 30.57% and 26.4%, respectively. Limitations Observational study. Conclusion Right-sided retroflexion was successful in most of our cohort with a statistically significant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. (Clinical trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.)

Background Recent medical literature on novel lumen-apposing stents for the treatment of pancreatic fluid collections (PFCs) is limited by small numbers, solo operators, and single-center experience. Objective To evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of PFCs. Design Retrospective case series. Setting Thirteen tertiary and private health care centers across Australia. Patients Forty-seven patients (median age 51 years) who underwent endoscopic management of PFCs. Intervention Insertion of FCSEMS after PFC puncture under EUS guidance. A subgroup of 9 patients underwent direct endoscopic necrosectomy. Main Outcome Measurements Technical and clinical success rate, adverse event rate. Results The technical success rate was 53 of 54 patients (98.1%), and the initial clinical success rate was 36 of 47 (76.6%), which was sustained for more than 6 months in 34 of 36 (94.4%). Early adverse events included 4 cases (7.4%) of stent migration during direct endoscopic necrosectomy, 4 cases (7.4%) of sepsis, 1 case (1.9%) of bleeding, and 1 case (1.9%) of stent migration into the fistula tract. Late adverse events were 6 (11.1%) spontaneous stent migrations, 3 (5.6%) recurrent stent occlusions, 3 (5.6%) tissue ingrowth/overgrowth, and 2 (3.7%) bleeding into PFC. The majority of stents inserted (48 of 54, 88.9%) and removed (31 of 35, 88.6%) in our study were described by the operator as superior to pigtail stents with regard to ease of use. Limitations Retrospective study. Conclusion Although FCSEMSs are technically easier to insert and remove compared with traditional pigtail stents, there are significant limitations to the widespread use of FCSEMSs in the management of PFCs. These include cost, adverse events, and lower-than-expected resolution rates.

Background Despite having one of the highest rates per capita for colonoscopy worldwide, colorectal cancer remains the second most commonly diagnosed malignancy in Australia. Objective Our aim was to document colonoscopy/polypectomy practice nationwide and assess whether significant differences exist. Design Observational study. Setting Online survey conducted nationally in 2012. Participants Medical practitioners registered with the Gastroenterological Society of Australia practicing colonoscopy. Main Outcome Measurements Rates of polypectomy techniques for varying polyp sizes, postpolypectomy bleeding prophylaxis techniques, and adenoma detection practices. To assess whether variations exist according to practice location, specialty, and experience and comparison of practice with a previous American cohort. Results Of the 846 members contacted, 244 (28.8%) responded. The cohort consisted primarily of consultant gastroenterologists (182/244, 74.6%). The cold-snare technique was preferred (165/244, 67.6%) for polyps 3 mm in size; however, this decreased rapidly with increasing polyp size (5 mm [120/244, 49.2%] and 7-9 mm [18/244, 7.4%]). EMR was the preferred method of resection for polyps 7 to 9 mm in size (148/244, 60.7%). The withdrawal technique predominantly consisted of double-passing high-risk areas and rectal retroflexion (134/244, 54.9%). Significant differences across specialty, location, and experience included polypectomy method for diminutive polyps, the use of EMR, and retroflexion. Limitations Survey-based study and response rate. Conclusion Although variations in colonoscopy and polypectomy practice exist, the majority of our cohort performs cold-snare polypectomy for diminutive polyps and pass high-risk, poorly visualized areas twice on withdrawal. This is a significant shift in practice from that of the U.S. cohort studied 10 years earlier.

An American kindred was found to have hereditary amyloidosis with cutaneous and cardiac involvement. Characterization of fibrils isolated from skin identified the amyloid protein as the N-terminal 90 to 100 residues of apolipoprotein A-1. Sequence of the apolipoprotein A-1 gene was normal except for a G/C transversion at position 1638 which predicts an Arg to Pro substitution at residue 173. This mutation, unlike previously described amyloidogenic mutations is not in the N-terminal fragment which is incorporated into the fibril. The mutation is at the same residue as in apolipoprotein A-1 Milano (Arg173Cys) which does not result in amyloid formation. Decreased plasma HDL cholesterol levels in carriers of the Arg173Pro mutation suggest an increased rate of catabolism as has been shown for the amyloidogenic Gly26Arg mutation. This suggests that altered metabolism caused by the mutation may be a significant factor in apolipoprotein A-1 fibrillogenesis.

to compare the comprehension gained by standard consent (SC) vs a unique interactive multimedia presentation (IMP), for radical prostatectomy (RP), as informed consent for RP requires that the patient understands the procedure and potential complications.forty patients undergoing RP were prospectively randomized to SC or IMP, followed by a 26-question test on critical aspects of the surgery and its implications. The groups were crossed over and re-tested, with a subsequent statistical analysis. SC involved typical verbal interaction and consultation with physicians and nurses, whilst the IMP provided consistent and animated information on these topics, and included multiple-choice questions probing understanding of key points. Progression through the IMP only occurred with correct responses; incorrect responses prompted a review of the information before repeating the question. Telephone interviews assessed usability, overall understanding, educational level and primary language.the patient groups had similar demographics. The IMP group (78%) had significantly higher knowledge test scores (P0.001) than the SC group (57%), suggesting a better understanding of the implications of surgery. This was maintained on crossover, with the SC group scores improving by 11% compared to testing before IMP (P0.001). The initial IMP group scores were unchanged on crossover and repeat testing (P0.05).IMP provides better patient understanding than SC for RP, by ensuring that the procedure and risks have been explained consistently, and by actively testing the patient. Such tools assist in obtaining ethical and legally informed consent, thus increasing patient knowledge whilst reducing patient anxiety and potential dissatisfaction or medico-legal consequences when less than ideal outcomes occur.

Skin reactions are common in the workplace. The skin, which constantly is exposed to chemicals and industrial processes, develops inflammatory reactions, most commonly dermatitis, which may have an allergic or irritant basis. The epidemiology, pathophysiology, and clinical features of common occupational dermatoses are discussed. Irritant, allergic, and urticarial contact reactions are compared, and their clinical features are outlined. Important occupational irritants and allergens, their sources, and the industries in which they most commonly are found are listed. The prognosis and therapy of these occupational reactions are examined.

Rosacea is a chronic skin disease that requires long-term therapy. Oral antibiotics and topical metronidazole successfully treat rosacea. Because long-term use of systemic antibiotics carries risks for systemic complications and adverse reactions, topical treatments are preferred.To determine if the use of topical metronidazole gel (Metrogel) could prevent relapse of moderate to severe rosacea.A combination of oral tetracycline and topical metronidazole gel was used to treat 113 subjects with rosacea (open portion of the study). Successfully treated subjects (n = 88) entered a randomized, double-blind, placebo-controlled study applying either 0.75% topical metronidazole gel (active agent) or topical metronidazole vehicle gel (placebo) twice daily (blinded portion of the study).Subjects were enrolled at 6 separate sites in large cities at sites associated with major medical centers.One hundred thirteen subjects with at least 6 inflammatory papules and pustules, moderate to severe facial erythema and telangiectasia entered the open phase of the study. Eighty-eight subjects responded to treatment with systemic tetracycline and topical metronidazole gel as measured by at least a 70% reduction in the number of inflammatory lesions. These subjects were randomized to receive 1 of 2 treatments: either 0.75% metronidazole gel or placebo gel.Subjects were evaluated monthly for up to 6 months to determine relapse rates.Inflammatory papules and pustules were counted at each visit. Relapse was determined by the appearance of a clinically significant increase in the number of papules and pustules. Prominence of telangiectases and dryness (roughness and scaling) were also observed.In the open phase, treatment with tetracycline and metronidazole gel eliminated all papules and pustules in 67 subjects (59%). The faces of 104 subjects (92%) displayed fewer papules and pustules after treatment, and 82 subjects (73%) exhibited less erythema. In the randomized double-blind phase, the use of topical metronidazole significantly prolonged the disease-free interval and minimized recurrence compared with subjects treated with the vehicle. Eighteen (42%) of 43 subjects applying the vehicle experienced relapse, compared with 9 (23%) of 39 subjects applying metronidazole gel (P.05). The metronidazole group had fewer papules and/or pustules after 6 months of treatment (P.01). Relapse of erythema also occurred less often in subjects treated with metronidazole (74% vs 55%).In a majority of subjects studied, continued treatment with metronidazole gel alone maintains remission of moderate to severe rosacea induced by treatment with oral tetracycline and topical metronidazole gel.

Distinctive feature is not a unique concept within linguistic theory. It has two distinct theoretical bases: phonemic theory and generative theory. Phonemic theory assumes a direct correspondence between distinctive features (the elements of phonemes) and the speech signal. Although this assumption can be shown to be incorrect, it seems to be the one most widely held in speech science. Generative theory, on the other hand, assumes no such direct relation and consequently can account for certain linguistic phenomena that phonemic theory cannot. This theory then seems to be preferable to phonemic theory for a featural analysis of misarticulation. However, there is a problem. Chomsky and Halle’s system (generative theory) as it stands does not deal with the link between what it conceives to be the lowest level of linguistic structure (the phonetic matrix) and speech production. Therefore, Chomsky and Halle’s distinctive features cannot be applied fruitfully to all instances of misarticulation. The discrepancy that exists between phonological structure and the speech signal must be accounted for in a theory of speech production. This can be accomplished by recognizing a production matrix below the phonetic matrix, where segments are described in terms of production features. The crucial point is that no one-to-one relationship necessarily exists between distinctive features and production features.

Nine probands with pseudoxanthoma elasticum (PXE) and 65 of their relatives underwent clinical and histological investigation. Seven previously unrecognized cases were found through family studies. In addition to previously reported manifestations, massive uterine bleeding and hypothyroidism were noted. Three patients with gastrointestinal tract bleeding had predisposing lesions; possibly arterial abnormalities predispose to hemorrhage from gastrointestinal lesions. Dominant inheritance could not be documented, but autosomal recessive transmission could have occurred in four families. Findings in three families suggest that subjects heterozygous for a PXE gene may have increased susceptibility to gastrointestinal tract, degenerative vascular, and ocular disorders. The mode of transmission in the fifth family does not fit either a dominant or a recessive pattern. Firm evidence for genetic heterogeneity in PXE was not found but was adduced from the pattern of inheritance in this family.

Plasma lipoprotein alterations in nine insulin-dependent diabetics with hyperlipemia have been related to the lipid accumulating in eruptive xanthomas evolving in these patients. Histochemical and electron microscopic examination of xanthomas have been correlated with the lipid analyses in order to obtain additional evidence regarding the lipoprotein origin of lipids accumulating in the lesions. Both analytical and morphologic evidence suggested that circulating chylomicrons significantly contribute to the xanthoma lipids. All the patients had large quantities of circulating triglyceriderich chylomicrons which carried approximately 70% of the triglyceride found in the plasma. The fatty acid pattern of chylomicron and xanthoma triglycerides were similar. Triglyceride constituted the major lipid found in the xanthomas when they were sampled during their eruption. These findings, take in conjunction with histochemical and electron microscopic evidence of chylomicron particles in the dermal capillary walls, support the theory that blood lipoproteins, and particularly chylomicrons, permeated the vascular walls and the triglycerides carried by these lipoproteins apparently accumulated in tissue macrophages and perithelial cells which evolved into foam cells. Initiation of appropriate therapy resulted in clearance of the chylomicronemia and a concomitant resolution of the xanthomas as reflected by a decrease in total xanthoma lipid. Sequential studies of resolving xanthomas in five patients revealed that xanthoma triglyceride was mobilized more rapidly than cholesterol, resulting in a redistribution of the xanthoma lipids, so that the resolving lesions were cholesterol rich. Consistent with this change in lipid composition, correlative electron microscopy revealed loss of amorphous material from many of the foam cell vacuoles.

The transformation in vitro of the plasma free cholesterol first observed by Sperry has been further studied. The drop in free cholesterol occuring on the incubation of rat plasma has been shown to be due to esterification by fatty acids. Radioactive cholesterol incubated in vitro in rat or human plasma becomes incorporated into each of the cholesterol ester subfractions obtained by silicic acid column chromatography. Under similar conditions of incubation no incorporation of free fatty acids into any of the plasma ester fractions has been demonstrated. However, when [14C]linoleic acid-labeled lecithin is incubated in vitro with rat or human plasma, radioactive cholesterol linoleate is formed as well as 14C free fatty acid, triglycerides, mono- and diglycerides, and probably also cephalin. Similarly, when [14C]palmitic acid-labeled tripalmitin is incubated with rat or human plasma, [14C]cholesterol palmitate results as well as 14C-labeled free fatty acid, mono- and diglycerides, cephalin and lecithin. It is concluded that the preformed fatty acid esters of the plasma are the source of the fatty acids for the cholesterol esterification reaction in vitro.

The ability to recognize diverse clinical forms of xanthomas, such as tuberous, planar, eruptive and tendinous, is important in the detection of underlying systemic disease. A variety of primary genetic disorders, as well as numerous secondary conditions such as diabetes, obstructive liver disease, thyroid disease, renal disease, and pancreatitis, can lead to hyperlipoproteinemia that results in the formation not only of xanthomas but also of life-threatening vascular atherosclerosis. An understanding of the pathogenesis of the underlying lipoprotein alterations provides a rational approach to therapy utilizing dietary manipulations and drugs. Such treatment is capable of correcting most disorders of lipid metabolism, and, if appropriate therapy is initiated at the first sign of xanthoma evolution, it may prevent progression of atherosclerosis, provide resolution of xanthomas, and in some instances prevent serious pancreatitis.

A Student Attitude Survey was administered to high school seniors to determine attitudinal and behavioral factors associated with participation in a longitudinal cardiovascular risk factor screening program. Health beliefs, altitudes, and practices were assessed as were altruism, social skills, self-concept, conformity, and academic class standing. Male participants showed higher self-concept scores than non participants. Black participants were younger than black nonparticipants and black participants also showed greater perceived control over their health and more optimistic appraisals of the worth of medical research and practice. White male participants tended to be more likely to reamin home from school or to see a doctor when ill. These obervations suggest that attitudinal and behavioral factors related to participation in a health-related program can be assessed in childhood.

A 63-year-old white woman with perioral dermatitis, a sore tongue, and an erythematous dermatosis in the inframammary and perineal regions underwent surgical removal of a pancreatic glucagonoma. The patient's plasma and pooled normal human plasma containing Sigma glucagon were fed to human keratinocyte cultures and increased arachidonic acid levels by 300% and 200%, respectively, when compared to pooled normal human plasma with no added commercial glucagon. These experiments suggest that glucagon may increase inflammatory mediators such as arachidonic acid and its metabolites in the epidermis, causing the skin lesions seen in the glucagonoma syndrome.

The Bogalusa Heart Study has been highly successful in recruitment and screening of children and adolescents in Bogalusa, Louisiana. From 1973 to 1982 in four cardiovascular risk factor surveys, 80-93% of the biracial pediatric population was examined. Overall participation rates compare favorably with those of similar studies. The authors examine methods and strategies involved in obtaining community support, identifying and contacting the eligible population, and implementing recruitment campaigns. Several of the more successful motivational efforts are described. Attrition and the broader problem of decreasing participation rates in older adolescents are examined. Recommendations are advanced for dealing with this problem age group.

Children were selected from a total community survey and categorized into three blood pressure (BP) groups (low less than 10 percentile, midrange 10 to 90 percentile, high greater than 90 percentile) based on resting diastolic pressure (DBP). To examine the relationship of cardiovascular reactivity with BP levels 4 years later, three cardiovascular response tasks (orthostatic, handgrip, and cold pressor) were administered. Partial correlations, adjusted for initial resting BP, showed that peak BP responses to the three tasks were related to future resting systolic and diastolic BP. Further analyses showed that DBP reactivity was related to future BP tracking in children with high DBP levels. In the high DBP group, while resting DBP levels did not differ for trackers vs nontrackers, peak DBP responses to each of the three tasks did (orthostatic, p less than 0.001; handgrip, p less than 0.05; cold pressor, p less than 0.01). The combination of resting and peak BP levels may provide more powerful predictions of future BP levels in children.

Oral ketoconazole therapy was evaluated with 21 patients who had recalcitrant dermatophytosis. During an 18-week period, all patients, including three with organisms resistant to griseofulvin in vitro, showed impressive clinical improvement. The four patients without nail involvement became mycologically negative earlier than those with onychomycosis. The latter group showed progressive clearing of the nails, but only three were mycologically clear after 18 weeks. Adverse reactions to ketoconazole were negligible, and no patients required discontinuance of the drug. Ketoconazole appears to be a safe, effective drug for oral therapy of dermatophytoses in humans.

• We observed the autonomic nerve plexuses in the skin of an erythermalgic patient and a normal individual using the methods of acetylcholinesterase (AChE) histochemistry, catecholamine histofluorescence, and electron microscopy. The density of both AChE-positive and catecholamine-containing nerve terminals in the periarterial and sweat glandular plexuses was greatly reduced in the erythermalgic foot skin compared with those in unaffected skin from the same patient and in the foot skin of a normal individual. Ultrastructurally, the terminal axons containing either agranular (cholinergic) or small dense-cored (adrenergic) vesicles were present in the periarterial and periglandular regions of the erythermalgic skin, but the occurrence of these nerve terminals in the involved skin appeared to be much reduced in frequency compared with uninvolved skin and the skin of a normal individual. ( Arch Dermatol 1983;119:65-71)

The efficacy of ketoconazole was evaluated in twenty patients with chronic dermatophyte infections who had failed to clear with griseofulvin therapy. Trichophyton rubrum was the causative organism in nineteen of the patients, and Trichophyton mentagrophytes in one patient. Three of twelve organisms tested showed in vitro resistance to griseofulvin. Duration of infection ranged from 2 to 28 years. Patients received 200 to 400 mg of ketoconazole daily for periods up to 8 months. In addition, patients were followed for 5 months post-therapy to monitor recurrences. Clearing was seen clinically as early as 2 weeks, and by 18 weeks all patients showed marked improvement or clinical clearing, though only six achieved complete mycologic cure. Improvement followed a predictable sequence of sites, with lesions of the trunk healing first, followed by hands, feet, and finally, nails. After 8 months, though all patients showed proximal nail clearing, onychomycosis persisted in thirteen of twenty affected sites. By 5 months post-therapy, four of six patients who had achieved clearing of skin and nails showed recurrences. No significant side effects were observed during therapy, though rare, apparently idiosyncratic cases of hepatotoxicity have been reported. Ketoconazole is an effective therapeutic agent for griseofulvin-resistant dermatophytosis. Apparent cures may subsequently recur after discontinuation of therapy.

Sections 1 μ thick of epoxy-embedded, OsO4-fixed tissues were stained with 4% aqueous basic fuchsin at 70 C for 1 min, rinsed well and destained, also at 70 C, for 1 min. A 2% aqueous methylene blue solution, alkalinized to pH 12.5 by mixing 1 N NaOH with the dye on the slide in the proportion of about 2:1, was then allowed to act for 2 min at 23-27 C. The stain was rinsed off the slide, and the preparation air dried before applying a mounting medium and cover glass. The mounting medium consisted of immersion oil sealed with epoxy household cement. Stains had not faded after 1 yr. The method is simple, rapid (total time 4-5 min), and provides sharp contrast between cellular and connective tissue components.