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This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.

Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951-1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8.6 per cent mortality in the first 10 years of the period.

In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings occurred in only eight cases. Vague abdominal symptoms with increasing tenderness led to surgical exploration in most cases. Median patient delay was 34 hours and doctor's delay 15 hours. Resection was primarily nonfeasible in 28 cases. Primary resection without second-look operation was performed in 32 cases, in seven of which signs of anastomotic insufficiency appeared. In the remaining 20 cases, primary resection (18) and/or embolectomy (3/2) was followed by a planned second-look operation within 24 hours, when five resections were performed. In a patient with viable anastomosis at second look, there were late signs of anastomotic insufficiency. Although the data do not permit firm recommendations, use of second-look operation in patients with doubtful viability of the intestine may reduce the extent of resection at primary exploration and also the incidence of insufficient anastomosis.

A random comparison of early mobilization and chest physiotherapy (mainly breathing exercises) with or without bronchodilatating inhalations for prophylaxis against pulmonary complications in patients undergoing elective gall-bladder surgery is presented. The operation was performed with a subcostal incision and peroperatively, intercostal nerve block was administered. Preoperative pulmonary status (dynamic volume spirometry, peak expiratory flow rate, arterial blood gas analysis) showed no differences between the groups, and postoperative blood gas analysis and pulmonary X-ray or evident clinical findings did also not show any differences between the groups. Thus early mobilization was as effective in our study as the other prophylactic treatments. In patients without pulmonary disease perhaps early mobilization and efficient analgesia after surgery is as effective as more resource demanding physiotherapy for prophylaxis against postoperative pulmonary complications.

In a study in dogs the central haemodynamic effects of dextran 70 and dihydroergotamine, both separated and combined, were evaluated. Dextran 70 gave an increased cardiac output, and peripheral resistance was reduced. The volume of blood flow in the femoral vein increased, pressure recordings being mainly unchanged. Dihydroergotamine caused an increase in the systemic arterial, central venous and pulmonary artery pressure. Cardiac output was unchanged. Total peripheral resistance increased but pulmonary vascular resistance remained unchanged. The combination of dextran 70 and dihydroergotamine gave a rather more pronounced increase in pressure recordings, but the other parameters observed were only moderately affected.

The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with bilateral ascending phlebography on postoperative day 7. In the dextran 70 group, 5 of the 27 phlebographically studied patients had DVT, an incidence not significantly different from the 10 DVT among 28 patients given dextran 70 + dihydroergotamine. Bleeding complications showed no intergroup difference. The study did not confirm a beneficial effect of dextran 70 in combination with dihydroergotamine as compared with dextran alone in regard to thrombotic complications after surgery for hip fracture.

Injuries to the upper gastrointestinal tract occurring over a 30-year period in a geographically well defined region were analyzed. The incidence was low in comparison with other abdominal injuries, but duodenal and pancreatic injuries were increasingly common in the study's last decade. The stomach injuries were mainly caused by penetrating trauma. The duodenal and pancreatic injuries most commonly resulted from road-traffic accidents. Two duodenal injuries were overlooked at the initial exploration, in which the duodenum was incompletely exposed. Anastomotic insufficiency occurred in one of the three patients who underwent duodenal resection. Most of the pancreatic injuries were contusions that could be managed with drainage. The pancreas was severely damaged in five patients, all of whom had multiple intra-abdominal injuries. Three of the five patients died before or during operation.

The frequency of early and late complications of percutaneously inserted central venous catheters (CVC) was prospectively assessed. One hundred and fifty-one periods of catheterization (siliconized and heparinized polyethylene and teflon catheters), inserted mainly infraclavicularly and on the right side, were evaluated. Strict aseptic technique was used during insertion and daily care of the CVC. The only early complications noted were three cases of pneumothorax. No nerve injuries or arterial punctures were observed. Of 124 evaluated cases (96 arm-phlebography, 28 post-mortem) 16% developed thrombosis, and in one patient this probably resulted in fatal pulmonary embolism. Septicaemia was seldom seen: two cases were considered as proved and another two cases as probable. This study and other studies indicate that an aseptic technique is essential and perhaps even more important than using tunnelled versus percutaneously inserted catheters in respect of reducing infectious complications of central venous catheters.

Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road traffic accidents were the main cause of trauma (48% of cases). The incidence of motor-car accidents rose sharply during the first two decades of the study. Injuries to the liver and bile ducts and multiple intra-abdominal injuries were more common in the elderly than in younger patients, but injury to the abdominal wall was less common. A tendency towards more severe injuries and multiple trauma with extra-abdominal involvement emerged during the study period. The mortality rate was 27.6% in the patients older than 60, but 9.1% in the overall patient series with abdominal trauma. One-third of all the deaths among the older patients were directly due to the abdominal trauma. One consequence of the increasing numbers of old people in the general population is probably that more and more cases of abdominal trauma will be seen in the higher age groups.

Different results are obtained when DNA in aqueous solution and DNA in biological tissue are exposed to ultrasound. At intensities of ultrasound comparable to those applied clinically, ultrasonication is able to degrade purified DNA in aqueous solution, making ultrasonication a useful tool for preparing DNA fragments in vitro. Ultrasonic degradation of DNA in solution occurs by breaking hydrogen bonds and by single-strand and double-strand ruptures of the DNA helix. Two mechanisms are mainly responsible: cavitation and a thermal or mechanical effect. Stable cavitation is seen at low intensities of ultrasound. Increasing the intensity of the ultrasound above 2 W/cm2 is followed by increases in single-strand ruptures due to the creation of free radicals by transient cavitation. Following sonication, the distribution of the resulting DNA fragments approaches a lower size limit of 100-500 bp. Breaks in the DNA helix occur mainly between oxygen and carbon atoms, resulting in DNA fragments with a phosphorylated 5' end and a free alcohol at the 3' end. The relative lack of specificity in degrading the DNA helix makes ultrasonication a complementary alternative to the highly specific fragmentation obtained by restriction endonucleases.

Hemodynamic and hematologic responses to protamine sulfate reversal of heparin's anticoagulant effects were studied in 15 consecutive randomized patients undergoing aortic reconstructive surgery. In a double-blinded manner, patients were pretreated with either normal saline solution (n = 8) or protamine (0.75 mg/kg/3 min, n = 7) 5 minutes before heparinization (150 IU/kg). After aortic grafts were placed, protamine (1.5 mg/kg/3 min) was administered intravenously to reverse the heparin. Arterial blood pressure, heart rate, pulmonary artery and capillary wedge pressure, central venous pressure, and cardiac output were monitored, as were platelet count, white blood cell count, activated clotting time, total hemolytic complement levels, and C3a levels. Calculated parameters included systemic vascular resistance and pulmonary vascular resistance. Pretreatment with protamine compared with saline solution prevented the hypotension (+6 vs. -16 mm Hg, p less than 0.05) and declining pulmonary artery pressure (+1 vs. -7 mm Hg, p less than 0.01) observed with protamine reversal of heparin. Significant differences between the two groups in central venous pressure and pulmonary vascular resistance were of less clinical relevance. Protamine pretreatment lessened the thrombocytopenia found during reversal compared with saline-pretreated patients although the difference was not statistically significant. Minimal hypotension occurring after protamine pretreatment alone was not accompanied by hemodynamic or hematologic changes, other than decreased heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Dextran 70 and DHE are both effective in reducing the risk for postoperative thromboembolic complications. As they at least in part have different mechanisms of action it is important to analyse if their combination potentiates the prophylactic effect. Therefore it is necessary to study the effect on hemodynamics and tissue blood flow, a problem which is delt with in this report.MATERIAL AND METHODS: In 18 dogs the following parameters were followed: cardiac output, heart rate, arterial blood pressure, central venous pressure, pulmonary artery pressure, left atrium pressure and volume blood flow in the femoral vein. Blood flow distribution was determined by the radioactive microsphere technique.RESULTS: Dextran 70 gave an increase of cardiac output and femoral vein flow. Other hemodynamic parameters were mainly unaffected. Total peripheral resistance decreased. DHE increased arterial blood pressure, central venous pressure and pulmonary arterial pressure. Cardiac output and femoral vein flow were unchanged.Tissue blood flow increased in general slightly after infusion of dextran 70. No significant change in blood flow distribution was seen. DHE reduced pancreatic and thyroid blood flow and increased tissue blood flow to the central nervous system. The blood flow to other organs including the heart was unaffected. The combination of dextran 70 and DHE influenced hemodynamic parameters and flow distribution in an additative way.CONCLUSIONS: From this experimental study it is concluded that it is possible to combine dextran and DHE without inducing a circulatory overload. DHE increased tissue blood flow to the central nervous system.

Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The precoatings evaluated consisted of blood for 5 (Group I) or 15 min (Group II), fibronectin (Group IV), and cryoprecipitate (Group VI). In addition to endothelial cells subcultured immediately before labeling, cells subcultured 48 hours prior to labeling and kept in suspension were studied. Such cells were evaluated on grafts precoated with blood for 5 min (Group III) and fibronectin precoated surfaces (Group V). The amount of fibronectin that adhered to the graft surface with our technique was less den 1%. Seeding efficiency was higher with the blood precoated surfaces (5.3, 3.0, 2.2% in Groups I, II and III respectively) than fibronectin (1.7%, 1.7% in Groups IV, V respectively) or cryoprecipitate (1.9%, Group VI) precoated surfaces. No significant difference between cells immediately subcultured and these kept in suspension for 48 hours regarding adherence to blood (5.3 vs. 2.2%) or fibronectin precoated (1.7 vs. 1.7%) grafts was documented. The seeding efficiency of ePTFE grafts is low and further efforts to improve adherence must be made. From the present studies we recommend the use of blood precoating for about 5 min followed by cell incubation for approximately 10 min in order to achieve optimal seeding efficiency.

Intestinal injuries sustained by 101 Swedish patients during the period 1950-1979 are reviewed. The abdominal trauma was blunt in 78 cases and penetrating in 23. Small-bowel and mesenteric, but not large-bowel, injuries showed increasing frequency. This was associated with rising numbers of motorcar accidents. Injuries to other abdominal organs were found in 56 of the 101 patients, particularly in those with mesenteric or large-bowel trauma. Clear physical signs of intra-abdominal injury led to rapid surgical exploration in most cases, but some operations were performed after relatively long observation. Most injuries, including those in the colon, were treated with primary repair or resection. Decompressive colostomy or exteriorization were rarely performed. Deaths were mainly caused by other factors than the type of operation. The mortality rate (35%) was constant.

The frequency of abdominal injury is rising. In an analysis of 1,354 cases of closed abdominal trauma sustained during a 30-year period (1950-1979) in Skaraborg County, Sweden, a distinct increase was found in the numbers associated with sporting activities. The severity of the injuries caused by sports likewise showed an increase. The representation of injured organs was of the same order as in the total series of closed abdominal injuries. An analysis of the 136 cases of sports-associated injury is presented with regard to cause and type of the injuries, diagnosis and prognosis.

The aim of this study was to investigate whether pretreatment with drugs that interfere with platelet functions in different ways could modify the pulmonary vascular response in a porcine septic shock model. Septic shock was induced by i.v. infusion of live Escherichia coli bacteria. Bacteriemic animals were divided into five groups: untreated or pretreated with a thromboxane-A2 synthetase inhibitor (UK 38 485), a serotonin-receptor antagonist (ketanserin), a combination of these two drugs, or a platelet antiaggregating drug (dipyridamole). E. coli induced significant pulmonary hemodynamic and respiratory changes. The pulmonary responses to E. coli infusion were attenuated after pretreatment with UK 38 485 but unaffected by prior administration of ketanserin or dipyridamole. The combined pretreatment did not attenuate the pulmonary hypertension or other pulmonary responses to E. coli more than UK 38 485 alone. Dipyridamole did not alter the pulmonary circulation after bacterial infusion. It was concluded that thromboxane-A2 is an important, but not the only, mediator of the pulmonary vascular response in septic-shocked pigs and that factors such as serotonin and platelet aggregability seem to be of minor, if any, importance for the hemodynamic response.

Effects of anticoagulant and antiplatelet drugs on vascular smooth muscle cell plating efficiency and proliferation were assessed using in vitro tissue culture techniques. Canine carotid artery smooth muscle cells were derived, pooled and plated into tissue culture cluster wells to which various drugs were added. Regular beef lung and porcine intestinal and low molecular weight porcine intestinal heparins reduced smooth muscle cell counts. Among antiplatelet drugs, reduced smooth muscle cell counts were seen with dipyridamole and ibuprofen, as well as with the combinations of ASA and dipyridamole, and ASA and dazoxiben. Although in vitro results cannot necessarily be extrapolated to in vivo settings, especially in regard to antiplatelet drugs, results of this study indicate direct effects of certain commonly used clinical agents in reducing smooth muscle cell growth.

The role of serotonin (5-HT) in initial microvascular hemostasis is not fully understood. This study was made to evaluate the effect on hemostatic plug formation and laser-induced arteriolar microembolism of different substances which counteract the effect of 5-HT. Hemostatic plug formation time and stability was measured in the rabbit mesenteric microcirculation and laser-induced embolism in the rabbit ear chamber. Ketanserine, a selective 5-HT2-receptor blocker shortened arteriolar hemostatic plug formation time. Dihydroergotamine, an unselective blocker (with 5-HT-and alpha-adrenergic receptor affinity) increased venular hemostatic plug formation time and also decreased the hemostatic plug stability. Laser-induced platelet embolism was unaltered after both ketanserine and dihydroergotamine administration. The magnitude of these changes seems to exclude an important effect of 5-HT in initial microvessel hemostasis or on platelet activity.

The activity of p-hydroxyphenylpyruvate hydroxylase (EC 1.14.2.2) has been determined in fine-needle aspiration biopsies from reference subjects with and without liver disease, patients with hereditary tyrosinemia, and the mother of children with hereditary tyrosinemia. With the assay technique a 0.2 % conversion of substrate to product was clearly detectable. As reference, other enzyme activities were determined in the same homogenate, i.e. aspartate aminotransferase (EC 2.6.1.1), lactate dehydrogenase (EC 1.1.1.27), alanine aminotransferase (EC 2.6.1.2), glycerol-3-phosphate dehydrogenase (EC 1.1.1.8), and sorbitol dehydrogenase (EC 1.1.1. 14). p-Hydroxyphenyl-pyruvate hydroxylase activity could be determined in all reference subjects. There was a considerable interindividual variation, but values obtained from duplicate biopsies on the same patient showed good agreement. In the heterozygote for hereditary tyrosinemia, the p-hydroxyphenylpyruvate hydroxylase activity fell within the range for the refere...

Case records of 417 patients, from a well-defined area, who were hospitalized because of blunt renal trauma during the period 1950-1979 were analyzed. The incidence increased during the final decade, corresponding to a rising incidence of motor traffic accidents and sports injuries. Young patients, between 10 and 29 years of age, were responsible for the increase and half of all patients were in this age group. Associated injuries were frequent. Emergency urography was rare during the earlier part of the investigation period, but the frequency increased strongly thereafter. Treatment was mainly conservative (nonoperative) except in patients with major renal injuries. Nephrectomy was performed in 22 patients. Reconstructive surgery was performed especially in patients with intermediate renal injuries during the final decade. The total mortality was 6.5%. Only 7 patients (1.7%) died from the renal injury. A dramatic reduction in the hospitalization time was noted.

A recommendation to the Union concerning the construction of certain tables was accepted.A discussion was opened on the subject of collaboration in the study of open clusters. An application to the General Assembly was passed for a recommendation as follows: “That the Union call attention to the important problems connected with the open clusters and determinations of proper motions, radial velocities, magnitudes and spectra along the lines already inaugurated at several observatories.”It was agreed that Dr Mineur should approach the observatories of the Carte du Ciel on the subject of photographing the open clusters for the future determinations of proper motions.

The acting chairman read a letter from the President of the Commission, Mr F. H. Seares, calling the attention of the Commission to certain points of importance which might be taken up for discussion. In the course of this discussion Dr H. Shapley invited cooperation with the Harvard Observatory on the work of unification of the magnitude systems in the northern and southern sky.After a discussion on the problems of standardizing colour filters and photographic plates used in stellar photometry the recommendation suggested by Dr Shapley that all engaged in photometric research publish promptly the characteristics of their instruments, colour filters, etc., was adopted.

Background We investigated several adjuvants for their effects on the humoral immune response in both mice and cattle using the central domain of congopain (C2), the major cysteine protease of Trypanosoma congolense, as a model for developing a vaccine against animal trypanosomosis. The magnitude and sustainability of the immune response against C2 and the occurrence of a booster effect of infection, an indirect measure of the presence of memory cells, were determined by ELISA, while spectrofluorometry was used to determine and measure the presence of enzyme-inhibiting antibodies. Results Mice immunized with recombinant C2 in TiterMax™, Adjuphos™, purified saponin Quil A™ or Gerbu™ showed the best response according to the evaluation criteria and the latter three were chosen for the cattle vaccination study. The cattle were challenged with T. congolense four and a half months after the last booster. Cattle immunized with recombinant C2 in purified saponin Quil A™ showed the best antibody response according to the measured parameters. Conclusions We identified purified saponin Quil A™ as a good adjuvant for immunizations with C2. The results from this study will be useful in future attempts to develop an effective anti-disease vaccine against African trypanosomosis.